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1626 Medical Center
El Paso, Texas
p. 915.782.4000
1.844.PRC.TX10
www.aliviane.org
www.prc10.net
Regional Needs Assessment 2018
REGION 10: FAR WEST TEXAS
PREVENTION RESOURCE CENTER 10
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Table of Contents Executive Summary ...................................................................................................................... 4
Prevention Resource Centers ..................................................................................................... 5
Introduction ................................................................................................................................. 11
Methodology .............................................................................................................................. 12
Regional Demographics............................................................................................................ 15
Population ................................................................................................................................... 16
General Socioeconomics ......................................................................................................... 23
Education .................................................................................................................................... 30
Criminal Activity .......................................................................................................................... 36
Social Factors .............................................................................................................................. 48
Accessibility ................................................................................................................................. 53
Alcohol ......................................................................................................................................... 53
Prescription Drugs and Opiates ................................................................................................ 59
Special Topics: Opioids ............................................................................................................. 69
Region 10 Current Use ............................................................................................................... 69
Consequences ............................................................................................................................ 73
Legal Consequences ................................................................................................................. 74
Drug and/or Alcohol Related Inmate Population ................................................................. 74
Environmental Protective Factors ............................................................................................ 76
Overview of Protective Factors ................................................................................................ 76
Community Domain ................................................................................................................... 76
School Domain ........................................................................................................................... 81
Region in Focus ........................................................................................................................... 82
Gaps in Services .......................................................................................................................... 83
Gaps in Data ............................................................................................................................... 83
Regional Partners ........................................................................................................................ 84
Regional Successes .................................................................................................................... 84
Conclusion ................................................................................................................................... 85
Key Findings ................................................................................................................................. 86
Moving Forward .......................................................................................................................... 87
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Appendix A Glossary of Terms .................................................................................................. 88
Appendix B List of Tables ........................................................................................................... 91
Appendix C List of Figures ......................................................................................................... 94
References .................................................................................................................................. 95
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Executive Summary The purpose of the Prevention Resource Center for Region 10 is to collect and distribute data among
community stakeholders, coalitions, agencies, hospitals and law enforcement. The overall purpose is to
serve, advocate and align prevention efforts for the residents living within the 6 counties. The PRC as a
data repository, aims to eliminate duplicative efforts in the collection and distribution of substance use
data for the region. This approach in collaborating with various agencies, strengthens relationships in
their effort to prioritize the needs of the communities, while tracking activities across the 6 counties.
The organizations and agencies who participated with the PRC Region 10 throughout the year are
committed to addressing health disparities and inequities. The Regional Needs Assessment includes
data from all diverse populations living along the U.S. - Mexico Border. The assessment aids in long
term strategic prevention planning, summary of statistics relevant to risk and protective factors
associated with drug use, as well as consumption patterns and consequences data. The assessment
also offers an insight to gaps in services and data availability challenges.
Prevention Resource Center - Region 10 data sources
The health assessment (what does the data show?) was a compilation of elicited information from
community members and stakeholders related to the issues of substance use. Collected data came
from community and coalition meetings, presentations, data requests, focus groups, conferences, and
one-on-one meetings with stakeholders across agencies in healthcare, law enforcement and education.
Much of the data collected was made much easier by the formation of workgroups and a task force
committed in identifying the needs of the communities, along with viable data that painted a clearer
picture in the health needs of our region. The vision of a healthier community by the participating
providers was a driving force for many of the events, publications and media campaigns that arose from
the data collection process.
Below are a few of the partners that participated in the process of data collection, formation of working
groups, and continued collaborative support for the PRC-Region 10. The gathering of information for
the assessment was made easier by their need to address priority health issues for the region:
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Prevention Resource Center - Region 10 key findings
Findings for Region 10 has found all 6 counties experience a high rate of tobacco use, marijuana use and
continued high rates of underage drinking. The region has also experienced increased use of
prescription medication and methamphetamine use.
The data collected for the RNA is an ideal starting point for prevention/intervention providers to
coordinate with each other in addressing needed treatment options along with changes in the U.S.
healthcare landscape.
Substance use was called out primarily by treatment providers, law enforcement agencies and key
stakeholder discussions. The available data across both youth and adult populations suggest that
Region 10 data on alcohol consumption puts it above the state average. Data from Monitoring the
Future, and the Texas State School Survey suggest that youth and adolescents have initiated marijuana
use by age 12. The compiled seizure data from the law enforcement community also suggests increase
trafficking and use of methamphetamine use for the region.
Prevention Resource Centers Our Purpose
Prevention Resource Centers (PRC) are a program funded by the Texas Health and Human Services
Commission (HHSC) to provide data and information related to substance use and misuse, and to
support prevention collaboration efforts in the community. There is one PRC located in each of the
eleven Texas Health Service Regions (see Figure 1) to provide support to prevention providers located
in their region with substance use data, trainings, media activities, and regional workgroups.
Prevention Resource Centers have four fundamental objectives related to services provided to partner
agencies and the community in general: (1) collect data relevant to alcohol, tobacco, and other drug use
among adolescents and adults and share findings with community partners (2) ensure sustainability of a
Regional Epidemiological Workgroup focused on identifying strategies related to data collection, gaps
in data, and prevention needs, (3) coordinate regional prevention trainings and conduct media
awareness activities related to risks and consequences of ATOD use, and (4) conduct voluntary
compliance checks and education on state tobacco laws to retailers.
Efforts carried out by PRCs are focused on the state’s three prevention priorities of underage drinking,
use of marijuana and other cannabinoids, and prescription drug misuse.
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Figure 1. Map of Health Service Regions serviced by the Prevention Resource Centers
Regional PRCs are tasked with compiling and synthesizing data and disseminating findings to the
community. Data collection strategies are organized around risk and protective factors, consumption
data, and related consequences associated with substance use and misuse. PRCs engage in building
collaborative partnerships with key community members who aid in securing access to information.
How We Help the Community
PRCs provide technical assistance and consultation to providers, community groups, and other
stakeholders in identifying data and data resources related to substance use or other behavioral health
indicators. PRCs work to promote and educate the community on substance use and misuse and
associated consequences through various data products, media awareness activities, and an annual
regional needs assessment. These resources and information provide stakeholders with knowledge and
understanding of the local populations they serve, help guide programmatic decision making, and
provide community awareness and education related to substance use and misuse. Additionally, the
program provides a way to identify community strengths as well as gaps in services and areas of
improvement.
Conceptual Framework
As one reads through this needs assessment, two guiding concepts will appear throughout the report: a
focus on the youth population and the use of an empirical approach from a public health framework.
For the purpose of strategic prevention planning related to drug and alcohol use among youth
populations, this report is based on three main aspects: risk and protective factors, consumption
patterns, and consequences of substance misuse and substance use disorders (SUDs).
Adolescence
The World Health Organization (WHO) identifies adolescence as a critical transition in the life span
characterized by tremendous growth and change, second only to infancy. This period of mental and
physical development poses a critical point of vulnerability where the use and misuse of substances, or
other risky behaviors, can have long-lasting negative effects on future health and well-being. This focus
Region 1 Panhandle and South Plains Region 2 Northwest Texas Region 3 Dallas/Fort Worth Metroplex Region 4 Upper East Texas Region 5 Southeast Texas Region 6 Gulf Coast Region 7 Central Texas Region 8 Upper South Texas Region 9 West Texas Region 10 Upper Rio Grande Region 11
Rio Grande Valley/Lower South Texas
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of prevention efforts on adolescence is particularly important since about 90 percent of adults who are
clinically diagnosed with SUDs, began misusing substances before the age of 18. 1
The information presented in this document is compiled from multiple data sources and will therefore
consist of varying demographic subsets of age which generally define adolescence as ages 10 through
17-19. Some domains of youth data conclude with ages 17, 18 or 19, while others combine “adolescent”
and “young adult” to conclude with age 21.
Epidemiology: The WHO describes epidemiology as the “study of the distribution and determinants of
health-related states or events (including disease), and the application of this study to the control of
diseases and other health problems.” This definition provides the theoretical framework through which
this assessment discusses the overall impact of substance use and misuse. Through this lens,
epidemiology frames substance use and misuse as a preventable and treatable public health concern.
The Substance Abuse and Mental Health Services Administration (SAMHSA) establishes epidemiology
to identify and analyze community patterns of substance misuse as well as the contributing factors
influencing this behavior. SAMHSA adopted an epidemiology-based framework on a national level
while this needs assessment establishes this framework on a regional level.
Socio-Ecological Model: The Socio-Ecological Model (SEM) is a conceptual framework developed to
better understand the multidimensional factors that influence health behavior and to categorize health
intervention strategies.2 Intrapersonal factors are the internal characteristics of the individual of focus
and include knowledge, skills, attitudes, and beliefs. Interpersonal factors include social norms and
interactions with significant others, such as family, friends, and teachers. Organizational/institutional
factors are social and physical factors that indirectly impact the individual of focus (e.g., zero tolerance
school policies, classroom size, mandatory workplace drug testing). Finally, community/societal factors
include neighborhood connectedness, collaboration between organizations, and policy.
The SEM proposes that behavior is impacted by all levels of influence, from the intrapersonal to the
societal, and that the effectiveness of health promotion programs is significantly enhanced through the
coordination of interventions targeting multiple levels. For example, changes at the community level
will create change in individuals and support of individuals in the population is essential for
implementing environmental change.
Risk and Protective Factors
Researchers have examined the characteristics of effective prevention programs for more than 20
years. One component shared by effective programs is a focus on risk and protective factors that
influence substance misuse among adolescents. Protective factors are characteristics that decrease an
individual’s risk for a substance use disorder. Examples may include factors such as strong and positive
family bonds, parental monitoring of children's activities, and access to mentoring. Risk factors are
characteristics that increase the likelihood of substance use behaviors. Examples may include unstable
home environments, parental use of alcohol or drugs, parental mental illnesses, poverty levels, and
1 The National Center on Addiction and Substance Abuse at Columbia University. 2011. CASA analysis of the National Survey on Drug Use and Health, 2009 [Data file]. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration.
2 McLeroy, KR, Bibeau, D, Steckler, A, Glanz, K. (1988). An ecological perspective on health promotion programs. Health Education & Behavior, 15(4), 351-377.
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failure in school performance. Risk and protective factors are classified under four main domains:
societal, community, relationship, and individual (see Figure 2).3
Figure 2. Examples of risk and protective factors within the domains of the Socio-Ecological Model
Source: Urban Peace Institute. Comprehensive Violence Reduction Strategy (CVRS).
http://www.urbanpeaceinstitute.org/cvrs/ Accessed May 29, 2018.
Consumption Patterns
For the purpose of this needs assessment, and in following with operational definitions typically
included in widely used measures of substance consumption, such as the Texas School Survey of Drug
and Alcohol Use (TSS)4, the Texas Youth Risk Surveillance System (YRBSS)5, and the National Survey
on Drug Use and Health (NSDUH)6, consumption patterns are generally operationalized into three
categories: lifetime use (ever tried a substance, even once), school year use (past year use when
surveying adults or youth outside of a school setting), and current use (use within the past 30 days).
These three categories of consumption patterns are used in the TSS to elicit self-reports from
adolescents on their use and misuse of tobacco, alcohol (underage drinking), marijuana, prescription
drugs, and illicit drugs. The TSS, in turn, is used as the primary outcome measure in reporting on Texas
youth substance use and misuse in this needs assessment.
Due to its overarching and historical hold on the United States, there exists a plethora of information on
the evaluation of risk factors that contribute to Alcohol Use Disorder (AUD). According to SAMHSA,
AUD is ranked as the most wide-reaching SUD in the United States, for people ages 12 and older,
followed by Tobacco Use Disorder, Cannabis Use Disorder, Stimulant Use Disorder, Hallucinogen Use
3 Urban Peace Institute. Comprehensive Violence Reduction Strategy (CVRS). http://www.urbanpeaceinstitute.org/cvrs/. Accessed May 29, 2018. 4 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2016 State Report. 2016. http://www.texasschoolsurvey.org/Documents/Reports/State/16State712.pdf. Accessed May 30, 2018. 5 Texas Department of State Health Services. 2001-2017 High School Youth Risk Behavior Surveillance System Data. 2017. http://healthdata.dshs.texas.gov/HealthRisks/YRBS. Accessed April 27, 2018. 6 Substance Abuse and Mental Health Services Administration. National Survey on Drug Use and Health. 2016. https://www.samhsa.gov/data/sites/default/files/NSDUH-DetTabs-2016/NSDUH-DetTabs-2016.pdf. Accessed May 30, 2018.
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Disorder, and Opioid Use Disorder (presented in descending order by prevalence rates).7 When
evaluating alcohol consumption patterns in adolescents, more descriptive information beyond the
aforementioned three general consumption categories is often desired and can be tapped by adding
specific quantifiers (i.e., per capita sales, frequency and trends of consumption, and definitions of binge
drinking and heavy drinking), and qualifiers (i.e., consequential behaviors, drinking and driving, alcohol
consumption during pregnancy) to the operationalization process. For example, the National Institute
on Alcohol Abuse and Alcoholism (NIAAA) has created very specific guidelines that are widely used in
the in quantitative measurement of alcohol consumption.8 These standards define binge drinking as the
drinking behaviors that raise an individual’s Blood Alcohol Concentration (BAC) up to or above the level
of .08gm%, which is typically five or more drinks for men and four or more drinks for women, within a
two-hour time span. At-risk or heavy drinking, is defined as more than four drinks a day or 14 drinks per
week for men and more than three drinks a day or seven drinks per week for women. “Benders” are
considered two or more days of sustained heavy drinking. See Figure 3 for the NIAAA’s operational
definitions of the standard drink.
Figure 3. NIAAA (2004) rubric for operationalizing the standard drink by ounces and percent alcohol
across beverage type
Source: National Institute for Alcohol Abuse and Alcoholism. What is a “standard” drink?
https://www.rethinkingdrinking.niaaa.nih.gov/How-much-is-too-much/What-counts-as-a-drink/Whats-A-Standard-
Drink.aspx. Accessed May 24, 2018.
7 Substance Abuse and Mental Health Services Administration. Substance use disorders. https://www.samhsa.gov/disorders/substance-use. Updated October 27, 2015. Accessed May 29, 2018. 8 National Institute for Alcohol Abuse and Alcoholism. What is a “standard” drink? https://www.rethinkingdrinking.niaaa.nih.gov/How-much-is-too-much/What-counts-as-a-drink/Whats-A-Standard-Drink.aspx. Accessed May 24, 2018.
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Consequences
One of the hallmarks of SUDs is the continued use of a substance despite harmful or negative
consequences. The types of consequences most commonly associated with SUDs, the most severe of
SUDs being addiction, typically fall under the categories of health consequences, physical
consequences, social consequences, and consequences for adolescents. The prevention of such
consequences has received priority attention as Goal 2 (out of four goals) on the 2016-2020 NIDA
Strategic Plan titled Develop new and improved strategies to prevent drug use and its consequences.9
The consequences associated with SUDs tend to be developmentally, culturally, and contextually
dependent and the measurement and conceptualization of such associations has proven to be quite
difficult for various reasons, including the fact that consequences are not always caused or worsened by
substance use or misuse.10 Therefore, caution should be taken in the interpretation of the data
presented in this needs assessment. Caution in inferring relationships or direction of causality should be
taken, also, because only secondary data is reported out and no sophisticated analytic procedures are
involved once that secondary data is obtained by the PRCs and reported out in this needs assessment,
which is intended to be used as a resource.
Audience
Potential readers of this document include stakeholders from a variety of disciplines: substance use
prevention and treatment providers; medical providers; school districts and higher education;
substance use prevention community coalitions; city, county, and state leaders; and community
members interested in increasing their knowledge of public health factors related to drug consumption.
The information presented in this report aims to contribute to program planning, evidence-based
decision making, and community education.
The executive summary found at the beginning of this report will provide highlights of the report for
those seeking a brief overview. Since readers of this report will come from a variety of professional
fields, each yielding specialized genres of professional terms and concepts related to substance misuse
and substance use disorders prevention, a glossary of key concepts can be found in Appendix A of this
needs assessment. The core of the report focuses on risk factors, consumption patterns, consequences,
and protective factors. A list of tables and figures can be found in Appendix B and Appendix C.
9 National Institute on Drug Abuse. 2016-2020 NIDA Strategic Plan. 2016. https://d14rmgtrwzf5a.cloudfront.net/sites/default/files/nida_2016strategicplan_032316.pdf. Accessed May 29, 2018. 10 Martin, CS., Langenbucher, JW, Chung, Sher, KJ. Truth or consequences in the diagnosis of substance use disorders. Addiction. 2014. 109(11): 1773-1778.
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Introduction The Texas Health and Human Services Commission (HHSC) administers approximately 225 school and community-based prevention programs across 72 different providers with federal funding from the Substance Abuse Prevention and Treatment Block Grant to prevent the use and consequences of alcohol, tobacco and other drugs (ATOD) among Texas youth and families. These programs provide evidence-based curricula and effective prevention strategies identified by SAMHSA’s Center for Substance Abuse Prevention (CSAP). The Strategic Prevention Framework (SPF) provided by CSAP guides many prevention activities in
Texas (see Figure 4). In 2004, Texas received a state incentive grant from CSAP to implement the
Strategic Prevention Framework in close collaboration with local communities in order to tailor services
to meet local needs for substance abuse prevention. This prevention framework provides a continuum
of services that target the three classifications of prevention activities under the Institute of Medicine
(IOM), which are universal, selective, and indicated.11
The Health and Human Services Commission Substance Abuse Services funds Prevention Resource
Centers (PRCs) across the state of Texas. These centers are part of a larger network of youth prevention
programs providing direct prevention education to youth in schools and the community, as well as
community coalitions that focus on implementing effective environmental strategies. This network of
substance abuse prevention services work to improve the welfare of Texans by discouraging and
reducing substance use and abuse. Their work provides valuable resources to enhance and improve our
state's prevention services aimed to address our state’s three prevention priorities to reduce: (1)
underage drinking; (2) marijuana use; and (3) non-medical prescription drug abuse. These priorities are
outlined in the Texas Behavioral Health Strategic Plan developed in 2012.
Our Audience
Readers of this document include stakeholders from a variety of disciplines such as substance use
prevention and treatment providers; medical providers; school districts and higher education;
substance use prevention community coalitions; city, county, and state leaders; and community
members interested in increasing their knowledge of public health factors related to drug consumption.
The information presented in this report aims to contribute to program planning, evidence-based
decision making, and community education.
Purpose of This Report
This needs assessment reviews substance abuse data and related variables across the state that aid in
substance abuse prevention decision making. The report is a product of the partnership between the
regional Prevention Resource Centers and the Texas Department of State Health Services. The report
seeks to address the substance abuse prevention data needs at the state, county and local levels. The
assessment focuses on the state’s prevention priorities of alcohol (underage drinking), marijuana, and
prescription drugs and other drug use among adolescents in Texas. This report explores drug
11 SAMHSA. Strategic Prevention Framework. https://www.samhsa.gov/capt/applying-strategic-prevention-framework. Last updated June 5, 2017.Accessed July 30, 2017.
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consumption trends and consequences. Additionally, the report explores related risk and protective
factors as identified by the Center for Substance Abuse Prevention (CSAP).
Figure 4. Strategic Prevention Framework (SPF)
Source: SAMHSA. Strategic Prevention Framework. https://www.samhsa.gov/capt/applying-strategic-prevention-framework.
Last updated June 5, 2017. Accessed July 30, 2017.
Methodology Purpose
This needs assessment is a review of data on substance misuse, substance use disorders, and related
variables that will aid in substance misuse prevention decision making at the county, regional, and state
level. In this needs assessment, the reader will find the following: primary focus on the state-delineated
prevention priorities of alcohol (underage drinking), marijuana, prescription drugs, and other drug use
among adolescents; exploration of drug consumption trends and consequences, particularly where
adolescents are concerned; and an exploration of related risk and protective factors as operationalized
by CSAP.
Specifically, this regional needs assessment can serve in the following capacities:
To determine patterns of substance use among adolescents and monitor changes in substance
use trends over time;
To identify gaps in data where critical substance misuse information is missing;
To determine county-level differences and disparities;
To identify substance use issues that are unique to specific communities;
To provide a comprehensive resource tool for local providers to design relevant, data-driven
prevention and intervention programs targeted to needs;
To provide data to local providers to support their grant-writing activities and provide
justification for funding requests;
To assist policy-makers in program planning and policy decisions regarding substance misuse
prevention, intervention, and treatment at the region and state level.
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Process
The state evaluator and the regional evaluators collected primary and secondary data at the county,
regional, and state levels between September 1, 2017 and May 30, 2018. The state evaluator met with
the regional evaluators at a statewide conference in September 2017 to discuss the expectations of the
regional needs assessment for the fourth year.
Between September and July the State Evaluator meet with Regional Evaluators via bi-weekly
conference calls to discuss the criteria for processing and collecting data. The information is primarily
gathered through established secondary sources including federal and state government agencies. In
addition, region-specific data collected through local law enforcement, community coalitions, school
districts and local-level governments are included to address the unique regional needs of the
community. Additionally, qualitative data is collected through primary sources such as surveys and
focus groups conducted with stakeholders and participants at the regional level.
Primary and secondary data sources are identified when developing the methodology behind this
document. Readers can expect to find information from the American Community Survey, Texas
Department of Public Safety, Texas School Survey of Drug and Alcohol Use, and the Community
Commons, among others. Also, adults and youth in the region were selected as primary sources.
Qualitative Data Selection
During the year, focus groups, surveys and interviews are conducted by the Regional Evaluator to
better understand what members of the communities believe their greatest need to be. The
information collected by this research serves to identify avenues for further research and provide access
to any quantitative data that each participant may have access to.
Focus Groups
Participants for the focus groups are invited from a wide selection of professionals including law
enforcement, health, community leaders, clergy, high school educators, town councils, state
representatives, university professors, and local business owners. In these sessions, participants discuss
their perceptions of how their communities are affected by alcohol, marijuana, and prescription drugs.
Interviews
Interviews are conducted primarily with school officials and law enforcement officers. Participants are
randomly selected by city and then approached to participate in an interview with the Regional
Evaluator. Each participant is asked the following questions:
What problems do you see in your community?
What is the greatest problem you see in your community?
What hard evidence do you have to support this as the greatest problem?
What services do you lack in your community?
Other questions inevitably arise during the interviews, but these four are asked of each participant.
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Surveys
Occasionally, organizations approach the PRC asking for guidance to construct and administer surveys
in order to collect information about how their adolescents perceive and consume AOD. All survey
questions are either copied from tools that have been tested and vetted or they are subjected to
rigorous testing through focus groups or other research methods. Many of the questions used by the
PRC originate from the following survey tools:
40 Developmental Assets Survey
Youth Risk Behavior Surveillance System
Monitoring the Future
Texas School Survey
Longitudinally Presented Data In an attempt to capture a richer depiction of possible trends in the data presented in this needs assessment, data collection and reporting efforts consist of multi-year data where it is available from respective sources. Most longitudinal presentations of data in this needs assessment consist of (but are not limited to) the most recently-available data collected over three years in one-year intervals of data-collection, or the most recently-available data collected over three data-collection intervals of more than one year (e.g. data collection for the TSS is done in two-year intervals). Efforts are also made in presenting state-and national-level data with county-level data for comparison purposes. However, where it is the case that neither state-level nor national-level date are included in tables and figures, the assumption can be made by the reader that this data is not made available at the time of the data request. Such requests are made to numerous county, state, and national-level agencies in the development of this needs assessment.
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Regional Demographics Region 10: Upper Rio Grande Geographic Description
Approximately 931,965 thousand people lived in the
six-county region as of 2017. The racial and ethnic
population is predominantly Hispanic (81.23%), an
increase from last year’s reported percentage of
(77.25%), as the growth and demographics of the
region continue to diversify.
Texas Public Health Region 10 is comprised of six
Texas counties:
Brewster
Culberson
El Paso
Hudspeth
Jeff Davis
Presidio
Brewster County, was founded in 1887 and named after Henry Percy Brewster. Historical accounts
place the first European to set foot in Brewster as Álvar Núñez Cabeza de Vaca in 1535. Brewster
County is the largest county in Texas, located in the Trans-Pecos region of West Texas, it is the site
of Big Bend National Park, the largest park in the State of Texas. Alpine City, the county city, is the
largest town in Brewster County. Alpine is also home to Sul Ross University and is named after Texas
Governor Lawrence Sullivan Ross. The geographical makeup of Brewster County comprises 6,169
square miles of largely rough and mountainous terrain, with elevations ranging from 1,700 to 7,825 feet
above sea level. Brewster County is made up of rural communities, with abundant opportunities for
outdoor recreation including rafting, fishing, and camping. Since the county's creation, mining, the
railroad, wholesale trade, construction and commerce have been the principal economic activities.
Culberson County, was established in 1911 and named after David B. Culberson. Van Horn city is the
county seat and organized in 1912. Ranchers settled in the county with the opening of the railways.
Today Culberson County is best known for the Guadalupe Mountains National park. The county
comprises 3,815 square miles varying from mountainous to nearly level elevations, ranging from 8,751
feet on Guadalupe Peak to 3,000 feet in its shallow, stony, clam and sandy loams.
El Paso County, was first established in 1850 but has been recognized in the history books since 1598
when the Spanish explorer Don Juan de Onate celebrated a Thanksgiving mass in the county. The
region of El Paso was claimed by Texas as part of a treaty agreement with Mexico in 1846. El Paso
County was recognized as one of the safest places to live in 2017 and continuously ranks high for the
category each year. El Paso is also known for its abundance of sunshine and recognized nationally as
the only county to have mined, milled and smelted tin. El Paso County is home to Fort Bliss, Texas, and
several higher education universities such as the University of Texas at El Paso, Texas Tech Medical
Center, and Park University. El Paso is home to a large part of the colonias established along the U.S. -
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Mexico Border, with 90,000 people living in 200 known colonias. El Paso County is one of the largest
cities geographically resting on the Mexico border with a population of more than 900,000. It is
predominantly Hispanic (81.23%), and is also home to the Fort Bliss 1st Armored division, with 27,132
Active Duty soldiers, 2,198 Reservist, 39,790 Family members, 12,323 Civilians, 32,794 Retirees, and
38,622 Family Members Retirees on base, with a total supported population of 166,832, within the 2nd
largest military installation in the United States Armed Forces. 12
Hudspeth County, is located seventy miles southeast of El Paso. It is considered the Trans-Pecos
region of far west Texas. It is bordered by New Mexico to the north, the Mexican State of Chihuahua to
the south and El Paso to the west. Sierra Blanca was made the county seat in 1917. The county is 4,566
square miles of mountainous terrain ranging from 3,200 to 7,500 feet above sea level. During the 1800’s
it was a popular watering hole stop, for travelers on stagecoaches and wagons, many in route to San
Antonio Texas. With the gold rush of 1849 the trails intensified and farming and ranching were the
primary sources of employment, and still are today. Many of the ranches still house thousands of cattle
and sheep. In 2016, 78.44 percent of the population was Hispanic and 21.56 percent non-Hispanic.
Jeff Davis County, is comprised of 2,258 square mountainous miles, with numerous wildlife including
mule deer, pronghorn antelope, javelin and jacksnipe to name a few. Jeff Davis is best known for their
Davis Mountains and is considered the highest mountain range located directly with the state of Texas.
Jeff Davis County also houses the legendary Fort Davis where many battles occurred during the Civil
War. Much of the land is utilized by cattle ranchers who fill much of the wide open spaces. Ranching
and tourism continue to be the main industries for the county. The current population of Jeff Davis
County is 2,200 with a predominantly Hispanic population.
Presidio County, is geographically triangular and comprises of 3,857 square miles of terrain that
contrasts between plateaus and mountainous ranges. The area known as La Junta de Los Rios, is
believed to be the oldest cultivated farm in Texas. Presidio County organized in 1875 and is the 4th
largest county in Texas. Their economy is primarily based in agriculture for farms and cattle with 83
percent of their land used for that purpose. As of the 2010 census there are 7,304 people living in the
county, with 84% of the population predominantly Hispanic. Presidio County is best known for the
location of the mysterious Marfa lights.
Data for the geographic description comes from the U.S. Census.13
Population
Table 1 summarizes the population demographics for the six-county region. Approximately 25,145,561
residents live in Texas as of the 2010 census. The total population for Region 10 in 2017 was 931,965
with population projection estimates at a rate of 17.26% growth rate. Compared to the U.S. as a whole
as of July 1, 2017 Texas’ population estimate of 28,304,596 people, ranks it as the second-most
populous state. Below in Table 1 are the regional components of Texas’ significant population increases
during the 2010-2016 period. With projected population rates for 2017-2018 in Table 2 and Table 3.
12 The National Center on Addiction and Substance Abuse at Columbia University. 2011. CASA analysis of the National Survey on Drug Use and Health, 2009 [Data file]. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration.
13 U.S. Census Bureau, Geographical quick facts Texas counties, 2018.
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Note: A press release on May 24, 2018 identified 3 Texas cities with the largest population gains. San
Antonio, Dallas and Fort Worth, Texas topped the list, with San Antonio having an average increase of
66 people growth rate per day from 2016-2017. Fort Worth, Texas was reported to be the 15th most
populous city surpassing Indianapolis in 2016.
TABLE 1 - TEXAS POPULATION CHANGE PROJECTIONS, 2010-2016
Region 2010 Population 2016 Population Estimate Growth (+/-) Percent
1 839,736 899,512 28,564 3.40%
2 550,422 568,459 (381) -0.07%
3 6,733,271 7,596,324 685,254 10.18%
4 1,111,701 1,186,116 21,928 1.97%
5 767,306 808,167 7,700 1.00%
6 6,087,210 6,946,624 739,562 12.15%
7 2,948,316 3,411,407 346,474 11.75%
8 2,604,657 2,923,361 261,469 10.04%
9 571,870 614,031 67,319 11.77%
10 825,912 915,995 33,473 4.05%
11 2,105,704 2,370249 131,647 6.25%
Texas 25,146,561 27,862,596 2,323,009 10.8%
U.S. 308,758,105 323,127,517 14,369,408 4.7%
Source: U.S. Census Bureau, Population Division. Annual Estimates of the Resident Population for the United States. Last updated July 2017. Accessed May 18, 2018.
Table 2 shows the growth of each of the Region 10 counties from the years 2010-2016.
Source: U.S. Census Bureau American Fact Finder. American Community Survey population estimates. Last updated July 2017. Accessed May 18, 2018.
Region 10 Counties 2010 2011 2012 2013 2014 2015 2016
Brewster 9,270 9,354 9,243 9,273 9,123 9,099 9,200
Culberson 2,399 2,379 2,309 2,295 2,260 2,233 2,198
El Paso 803,641 819,471 830,853 831,218 834,190 833,783 837,918
Hudspeth 3,467 3,417 3,351 3,331 3,243 3,425 4,053
Jeff Davis 2,345 2,297 2,303 2,223 2,199 2,179 2,200
Presidio 7,876 7,747 7,557 7,282 7,040 6,881 6,958
TABLE 2 - REGION 10, POPULATION, 2010-2016
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Table 3 - Region 10, Projected Population rates by race, 2017
Source: Texas Department of State Health Services. Texas Population 2017 Projections. https://www.dshs.texas.gov/chs/popdat/ST2017.shtm. Accessed June 1 2018.
Table 4 - Region 10, Projected Population rates by race, 2018
Source: Texas Department of State Health Services Texas Population 2018 Projections. https://www.dshs.texas.gov/chs/popdat/ST2017.shtm. Accessed June 1 2018.
The demographic composition of each of the counties, as well as knowing the changes that occur over
time in population growth or decrease, helps in understanding the needs of the residents at the health
and social level.
Age
Below in Table 5, the United States vs. the Texas population is ranked 2nd behind California with a total
population of 28,704,330 as of estimated 2018 figures. Texas is considered the largest of the 50
contiguous U.S. states. Based on 2010 census data, population growth remains constant and has
increased from 25.1 million. Its current growth rate of 1.80% ranks 3rd in the country. Texas has 3 cities
with more than 1 million in population: Dallas, Houston, and San Antonio. El Paso is considered among
one of the 25 largest cities in the US along with Fort Worth and Austin, Texas. The growth rate for
Region 10 is currently 11% and currently is in the top 5 regions for overall growth in the State of Texas.
Region 10 Counties
Total Population 2017 Anglo Black Hispanic
Other
Brewster 9,971 5,295 79 4,338 259
Culberson 2,268 524 8 2,030 66
El Paso 904,586 98,091 21,996 763,039 21,430
Hudspeth 3,385 669 30 3,083 53
Jeff Davis 2,460 1,534 10 861 55
Presidio 8,485 1,179 27 7,129 150
Total 931,965 107,292 22,150 780,510 22,013
Region 10 Counties
Total Population 2018 Anglo Black Hispanic
Other
Brewster 9,894 5,293 80 4,273 248
Culberson 2,622 510 8 2,042 62
El Paso 920,987 97,098 22,106 779,717 22,066
Hudspeth 3,879 661 30 3,138 50
Jeff Davis 2,442 1,508 10 871 53
Presidio 8,494 1,168 27 7,156 143
Total 948,318 106,238 22,261 797,197 22,622
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TABLE 5 - TEXAS VS. US POPULATION BY AGE CATEGORY, 2017
2017 Children
0-18 Adults 19-25
Adults 26-34
Adults 35-54
Adults 55-64 65+
United States 24% 9% 12% 26% 13% 15%
Texas 28% 10% 13% 25% 11% 12%
Source: Kaiser Family Foundation estimates based on the Census Bureau's March Current Population Survey (CPS: Annual
Social and Economic Supplements). Published June 2017. Accessed May 13 2018.
Table 6, breaks down the Region 10 population by age category from under 1 years of age to 85 and
over for 2017.
TABLE 6 - REGION 10 POPULATION BY AGE CATEGORY, 2017
Source: Texas Department of State Health Services. Texas Population by age 2017. http://soupfin.tdh.state.tx.us/cgi-
bin/pop85a, Accessed June 6 2018.
Ages 45-85 and over
45 to 49 50 to 54 55 to 59 60 to 64 65 to 69 70 to
74 75 to
79 80 to
84 85 and Over
All Ages
County
Brewster 565 626 638 802 738 554 395 213 203 9,829
Culberson 144 158 170 161 159 126 91 73 63 2,594
El Paso 53,411 51,406 51,687 44,109 34,792 25,405 18,275 13,094 12,967 905,199
Hudspeth 211 233 296 270 206 183 154 91 70 3,831
Jeff Davis 108 157 192 254 281 225 147 85 75 2,437
Presidio 518 477 475 530 518 445 337 235 224 8,433
Region Total
54,957 53,057 53,458 46,126 36,694 26,938 19,399 13,791 13,602 932,323
Texas 1,851,643 1,766,365 1,750,715 1,521,959 1,238,087 907,059 597,678 397,245 370,979 28,853,424
Ages 1-44
Under 1
1 to 4 5 to 9 10 to 14 15 to 19 20 to 24 25 to 29 30 to 34 35 to 39 40 to 44
County
Brewster 111 438 528 539 643 784 504 534 527 487
Culberson 40 158 184 165 179 189 159 117 134 124
El Paso 15,993 60,936 66,855 68,469 72,375 77,275 73,868 57,834 52,187 54,261
Hudspeth 57 210 231 264 280 332 211 177 180 175
Jeff Davis 25 83 88 104 113 191 87 67 78 77
Presidio 146 522 561 571 690 634 393 370 358 429
Region Total
16,372 62,347 68,447 70,112 74,280 79,405 75,222 59,099 53,464 55,553
Texas 438,086 1,695,756 2,030,035 2,122,061 2,149,148 2,088,983 2,045,372 2,036,142 1,987,621 1,858,490
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Race/Ethnicity
Region 10 continues to be an increasingly diverse state with a large Hispanic representation (81.23%).
The table below shows the racial and ethnic make-up of Region 10 from 2017, 2016 and 2015.
TABLE 7 - TEXAS AND REGION 10 POPULATION BY RACE AND ETHNICITY, 2017
2017 Total Pop Anglo Black Hispanic Other
Brewster 9,971 5,295 79 4,338 259
Culberson 2,628 524 8 2,030 66
El Paso 904,586 98,091 21,996 763,069 21,430
Hudspeth 3,835 669 30 3,083 53
Jeff Davis 2,460 1,534 10 861 55
Presidio 8,485 1,179 27 7,129 150
Source: Texas Department of State Health Services. Texas Population 2017 projections. County Density as of Census Data 2010. https://www.dshs.texas.gov/chs/popdat/ST2017.shtm. Accessed June 21 2018.
TABLE 8 - TEXAS AND REGION 10 POPULATION BY RACE AND ETHNICITY, 2015, 2016
2015 Total Pop White alone
African American
American Indian
Asia alone
Pacific Islander
Some other race
Two or more races
Brewster 9,235 8,609 123 140 0 0 195 168
Culberson 2,296 2,069 9 11 0 3 170 34
El Paso 831,095 688,335 29,361 5,185 9,132 1,376 79,816 17,890
Hudspeth 3,330 3,020 42 0 26 0 180 62
Jeff Davis 2,232 2,028 7 29 24 0 140 4
Presidio 7,304 6,670 1 108 251 0 231 43
2016 Brewster
9,188
8,622
25
126
149
0
131
135
Culberson 2,259 1,767 9 0 0 3 378 102
El Paso 833,592 690,655 29,082 5,870 9,502 1,297 79,621 17,555
Hudspeth 3,481 2,741 44 0 45 0 589 62
Jeff Davis 2,221 2,144 12 13 18 0 26 8
Presidio 7,144 6,628 0 99 243 0 174 40
Source: U.S. Census Bureau American Community Survey 2014-2016. American Fact Finder. Last updated July 2017.Accessed June 16 2018.
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Concentrations of Populations
Texas’ land area of 261,249.64 square miles places it as the 2nd largest state, behind Alaska’s vast
663,267.26 square miles. Texas 103.18 persons per square mile (density) is very close to the national
average of 90.19. El Paso (822.74) has the highest population density in Region 10, and an overall rate
of 39.53 per square mile of the 21,699.44 total land area.
In Figure 1 below the population density is most visible in El Paso with the other counties having an
average of 1.13 rate of density for population habitation in Region 10.
FIGURE 5 - TEXAS DENSITY POPULATION
Source: U.S. Census Bureau Texas Density map 2016.
TABLE 9 - REGION 10 POPULATION DENSITY, 2016
Total Land Area in square miles
Population Density (per square mile)
Brewster 6,183.76 1.49
Culberson 3,812.16 0.59
El Paso 1,013.19 811.74
Hudspeth 4,570.53 0.76
Jeff Davis 2,264.56 0.98
Presidio 3,855.25 1.85
Region 10 21,699.44 39.53
Texas 261,249.64 103.18
United States 3,532,068.58 90.19
1
10
Source: U.S. Census Bureau. American Community Survey. American Fact Finder, 2017.
Accessed June 25, 2018.
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Public Health research has found both community-level factors and individual health behaviors directly
affect the differences in healthcare access, utilization of services, cost and location of health providers.
There are benefits to examining environment-specific factors that contributes to an individual’s overall
health. Many of the factors in an environment, interact or shape how one’s health may be effected.
Some characteristics of interest would include air quality, good housing, services (such as
transportation), community history, crime and reputation of an area. The well-being of an individual
can be a more complete picture when there is evidence both positive and negative within each of
distinct causal factors in urban and rural locations.
Table 10 is a breakdown of Region 10 for urban and rural populations.
TABLE 10 - REGION 10 URBAN AND RURAL POPULATION, 2017
Total Population
Urban Population
Rural Population
Percent Urban Percent Rural
Region 10 825,913 793,905 32,008 96.1% 3.8%
Brewster 9,232 6,013 3,219 65.1% 34.8%
Culberson 2,398 0 2,398 0% 100%
El Paso 800,647 783,238 17,409 97.8% 2.1%
Hudspeth 3,476 0 3,476 0% 100%
Jeff Davis 2,342 0 2,342 0% 100%
Presidio 7,818 4,654 3,164 59.5% 40.4%
Texas 25,145,561 21,298,039 3,847,522 84.7% 15.3%
United States 312,471,327 252,746,527 59,724,800 80.8% 19.1%
Source: U.S. Census Bureau. American Community Survey. American Fact Finder 2011-2016. Last updated July 2017. Accessed June 13, 2018.
Languages
As of 2017 more than 35% of Texas citizens speak a language other than English. Migration patterns
and the diversity of incoming immigrants increases the number of languages for the state overall.
Understanding the language population aids in the development of multi-lingual programming along
with appropriate information dissemination.
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TABLE 11 - REGION 10, POPULATION IN LIMITED ENGLISH LANGUAGE HOUSEHOLDS, 2016
Total Population Age 5+ Linguistically Isolated Population
Percent Linguistically Isolated Population
Region 10 789,870 138,023 17.47%
Brewster 8,680 388 4.47%
Culberson 2,139 472 22.07%
El Paso 767,080 134,399 17.52%
Hudspeth 3,264 789 24.17%
Jeff Davis County 2,166 233 10.76%
Presidio County 6,541 1,742 26.63%
Texas 24,985,749 1,942,413 7.77%
TABLE 12 - REGION 10 ENGLISH VS. SPANISH LANGUAGE POPULATION, 2014-2016
2014
2015
2016
Region 10 Total Pop
Speak only English
Spanish or Spanish Creole
Total Pop
Speak only English
Spanish or Spanish Creole
Total Pop
Speak only English
Spanish or Spanish Creole
Brewster 8,731 5,457 3,156 8,689 5,356 3,206
8,680 5,406 3,029
Culberson 2,178 693 1,473 2,120 683 1,426
2,139 734 1,405
El Paso 757,033 207,185 534,122 763,568 212,685 534,735
767,080 213,244 537,653
Hudspeth 3,111 663 2,426 3,109 741 2,342
3,264 710 2,483
Jeff Davis 2,211 1,258 922 2,177 1,234 913
2,166 1,287 858
Presidio 6,875 944 5,708 6,751 921 5,542
6,541 888 5,355
.
General Socioeconomics
Household Composition
Another way to gain a basic understanding of stresses to the family unit is the composition of the
household and the median family income. According to the US Census Bureau, there are approximately
201,514 family households in Region 10. The average family size in Texas is 2.81 in 2017, compared to
2.84 in 2016 and 2.75 in 2015.
El Paso County has the largest number of households in the region (195,728) with a median family
income of $62,049 in 2017 compared to $46,096 for 2016.
Source: U.S. Census Bureau. 2012-2016 American Community Survey 5-year estimates: Language Spoken at Home. American Fact Finder Results. Last updated July 2017.
https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_16_5YR_S1601&prodType=table. Accessed June 2018
Source: U.S. Census Bureau. 2012-2016 American Community Survey 5-year estimates: Limited English Language in Households. American Fact Finder Results. Census 2010. Accessed April 24, 2018.
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TABLE 13 - REGION 10, FAMILY HOUSEHOLD INCOME, 2016
2016 Total Family Households Average Family Income
Median Family Income
Region 10 201,541 $62,077 no data
Brewster 2,276 $76,141 $53,011
Culberson 526 $56,137 $38,977
El Paso 195,728 $62,049 $46,907
Hudspeth 706 $47,581 $29,405
Jeff Davis 585 $74,286 $62,566
Presidio 1,720 $50,284 $40,057
Texas 6,450,049 $88,231 $64,585
United States 77,608,829 $90,960 $67,871
TABLE 14 - REGION 10 MEDIAN FAMILY INCOME BY FAMILY COMPOSITION, 2016
2016
Married-Couple Families without Children
Married-Couple Families with Children
Single-Males without Children
Single-Males with Children
Single Females without Children
Single Females with Children
Brewster $63,315 $95,143 $50,599 no data $34,844 $27,031
Culberson $46,250 $61,364 $93,155 $26,607 no data $19,615
El Paso $57,728 $56,288 $43,779 $33,112 $36,934 $20,845
Hudspeth $36,806 $30,481 $18,068 no data no data $8,715
Jeff Davis $65,682 $54,013 no data no data no data no data
Presidio $39,583 $46,154 no data no data $60,589 $20,750
Texas $78,630 $81,385 $52,582 $39,700 $42,607 $25,006
United States $78,162 $87,757 $53,570 $39,618 $44,636 $25,130 Source: U.S. Census Bureau, American Community Survey 2012-2016. American Fact Finder. Accessed June 1 2018
Figure 6 - Percentage of population in poverty by County
4.99%
%
5.74%
Source: U.S. Census Bureau. 2012-2016 American Community Survey 5-year estimates: Family Household Income. American Fact Finder Results. Census 2010. Accessed May 15 2018.
2.6%
7.8%
12.04%
8.21
%
In Region 10, 8.16% of 842,165 individuals are living with an income at or below 50% of the Federal Poverty Level as of 2017. The indicator is a relevant data marker, as research has shown poverty creates barriers for many of the health services and other necessities contributing to a poor health status.
Data Source: U.S. Census Bureau. American Community Survey. American Fact Finder 2012-2016. Accessed May 28 2018.
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Hudspeth County, in Region 10, had the largest percentage of families whose income in the past 12
months is below the poverty level at 12.04%, compared to the State of Texas with an overall
percentage of 6.98%.
The Colonias of Region 10 Approximately 400,000 Texans live in colonias. Colonias are defined as any U.S.-Mexico border low-income community that lacks basic infrastructure systems: municipal water, municipal sewage, and piped natural gas. There are more than 2,294 of these communities bordering the Texas - Mexico landscape, with approximately 90,000 residents for Region 10 colonias. The proliferation of colonias in the region poses challenges for the counties and the lack of existing programs to improve the conditions. Many of these settlements were started by farmworkers and migrants who were unable to find
affordable housing. The Colonia Initiatives Program Office of the Texas Secretary of State reports El
Paso with the largest number of colonia communities (329). The remaining counties in Region 10 have
considerably less identified colonias, Brewster County (3), Culberson (2), Hudspeth (6), Jeff Davis (1),
and Presidio with (8) with a total county colonia population of 90,65314.
Furthermore, Far West Texas (namely El Paso County) is considered a High Intensity Drug Trafficking
Area by the Office of National Drug Control Policy (ONDCP)15, this along with the extreme poverty
places the colonias at a high risk for substance abuse/use where drugs may be readily available.
The residents are mostly migrating Hispanics whose Spanish is their primary language. The Colonias
lack many of the basic living necessities; such as running water, electricity, emergency services, public
14 Texas Secretary of State, Directory of Colonias Located in Texas, last updated March 2017. 15 Office of National Drug Control Policy, High Intensity Drug Trafficking Areas Program Report to Congress, retrieved May 2018.
The colonia home shown above is situated in a colonia
located in El Paso County. Photo credit: Colonias in Texas,
accessed June 19 2018, https://people.uwec.edu/ivogeler/w188/border/coloniasTX.
htm .
Figure 7 - Percent of Hispanics in El Paso
County by block group.
Figure 8 - Photo of a colonia homestead
in El Paso County.
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transportation and basic health services. Colonias can be described as areas full of disproportionate
health disparities.
The residents are mostly migrating Hispanics whose Spanish is their primary language. The Colonias
lack many of the basic living necessities; such as running water, electricity, emergency services, public
transportation and basic health services. Colonias can be described as areas full of disproportionate
health disparities.
The education level of the residents living in the colonias is much lower than at the county level.
Seventy-eight percent of the adult population in the colonias have an education level of high school or
less. Approximately 24% have some college compared to 28.1% of the overall rate in Texas. Specific
educational attainment data for just the El Paso colonias is not collected on a regular basis but are
included in the population totals of the Census Bureau as listed in the table below.
TABLE 15 - EDUCATIONAL ATTAINMENT - EL PASO COUNTY
COLONIAS BY ZIP CODE, 2012-2016
2012-
2016
High School graduate or
higher, percent of persons
age 25 years+
Bachelor's
degree or
higher, percent
of persons age
25 years+
79927 Socorro 57.3% 6.3%
79836 Clint 65.1% 16.4%
79928 Horizon 86.1% 18.9%
79838 San
Elizario 49.3% 8.7%
79853 Fabens 55.0% 3.4%
El Paso 78.6% 23.6%
Texas 82.3% 28.1%
One of the greatest barriers/gaps in receiving services underdeveloped communities that lack paved
roads or Individuals go without services due to their inaccessibility to many of the basic health needs.
The data below identifies the number of employed citizens in the catchment area, less than 2% use the
available public transit for commuting purposes.
Census Bureau, American Community Survey. Quick Facts 5
year Estimates 2012-2016. Accessed April 2018.
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TABLE 16 - PUBLIC TRANSIT COMMUTE USE FOR WORK, 2016
2016
Total Population
Employed Age
16+
Population
Using Public
Transit for
Commute to
Work
Percent Population
Using Public Transit
for Commute to Work
El Paso County, TX 345,010 5,065 1.47%
Texas 12,237,558 188,919 1.54%
United States 145,861,221 7,476,312 5.13%
Employment
According to the U.S. Department of Labor for 2017, the county in Region 10 with the highest unemployment rate was Presidio at 9.4% with a labor force of 3,024 individuals. Labor force is defined as the number of residents age 16 and older that are either working or looking for work. People who are not in the labor force do not work for a variety of reasons. These reasons include: retirement, school attendance, inability to perform available work, physical incapacity, or no work is available to them.
TABLE 17 - REGION 10, LABOR FORCE, EMPLOYED/UNEMPLOYED, 2017
Source: U.S. Department of Labor. Bureau of Labor Statistics. Unemployment Statistics by County. https://www.bls.gov/lau/#cntyaa. Accessed June 19 2018.
TANF Recipients
This indicator reports the percentage recipients per 100,000 populations receiving public assistance
income. Public assistance income includes general assistance and Temporary Assistance to Needy
Families (TANF). Separate payments received for hospital or other medical care (vendor payments) is
excluded. This does not include Supplemental Security Income (SSI) or noncash benefits such as Food
Stamps. El Paso County paid out the most in 2016 in aggregate dollars in the amount of $22,805,800
for 7,159 households.
Area Unemployment Rate %
Labor Force Employed Unemployed
United States
3.8 157,833,000 est. 149,929,000 est. 7,891,650 est.
Texas 4.3 13,531,442 12,953,874 577,568
Region 10 4.6 363,834 346,981 16,853
Brewster 3.5 3,921 3,784 137
Culberson 3.6 913 880 33
El Paso 4.6 353,387 337,112 16,275
Hudspeth 6.0 1,537 1,445 92
Jeff Davis 3.1 1,052 1,019 33
Presidio 9.4 3,024 2,741 283
Census Bureau. American Community Survey. Use of Public Transportation 5 year
Estimates 2012-2016. Accessed April 2018.
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TABLE 18 - REGION 10 HOUSEHOLDS WITH PUBLIC ASSISTANCE, 2016
TABLE 19 - REGION 10 HOUSEHOLDS WITH PUBLIC ASSISTANCE, 2015
Census Bureau. American Community Survey. Public Assistance by County 2015.
https://assessmsnet.communitycommons.org/CHNA/report?page=2&id=768&report type=libraryCHNA. Accessed June 2018.
Food Assistance Recipients
The information below is an estimated percentage of households receiving the Supplemental Nutrition
Assistance Program (SNAP) benefits. It is important to understand this indicator as it assesses many of
the vulnerable populations within the region that likely to have multiple issues, such as access to health
care, lack of social support and dealing with poverty. In Region 10, the county that receives the most
SNAP benefits is Presidio with 72.4% of the households of which 57.5% or households are below
poverty level.
Total Households
Households with Public Assistance
Income Percent Households with Public Assistance Income
Region 10 269,050 8,934 3.32%
Brewster 4,025 44 1.09%
Culberson 788 0 0%
El Paso 259,612 8,873 3.42%
Hudspeth 968 6 0.62%
Jeff Davis 1,023 11 1.08%
Presidio 2,634 0 0%
Texas 9,149,196 154,152 1.68%
United States 116,926,305 3,223,786 2.76%
Total Households Receiving Public
Assistance Income
Aggregate Public Assistance Dollars
Received
Average Public Assistance
Received (in USD)
Region 10 7,237 23,034,900 $3,182
Brewster 59 207,900 $3,523
Culberson 0 0 no data
El Paso 7,159 22,805,800 $3,185
Hudspeth 9 21,200 $2,355
Jeff Davis 6 0 $0
Presidio 4 0 $0
Texas 147,100 441,170,100 $2,999
United States
3,147,577 10,499,747,500 $3,335
Census Bureau, American Community Survey. Public Assistance by County 2016.
https://assessmsnet.communitycommons.org/CHNA/report?page=2&id=768&report type=libraryCHNA.
Accessed June 18 2018.
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TABLE 20 - REGION 10 SNAP BENEFITS BY COUNTY, 2017
Free and Reduced-Price School Lunch Recipients
The National School lunch program served over 4.89 million free or reduced lunches at a cost of $30
million in 2017. Within Region 10, the six counties with 182,602 public school students, 119,188 were
eligible for the free in-school meals in 2016. The indicator is important in assessing how the safety net
of meals for kids crosses over in other risk factors associated with poor households. Additionally, the
USDA found that 32% of school age children are found to be either obese or overweight, indicating
poor food choices. Among eligible students receiving free lunches, the program found those recipients
consuming less sweets and more fruits and vegetables.
The table below shows local, state and national trends eligible for free and reduced lunches across the
years 2010-2016. The national number table shows a slight decrease in the number of school lunches
dispersed as of March 2018. *Data is subject to change due to 9 month-12 school calendar calculations.
TABLE 21 - REGION 10 ELIGIBLE STUDENTS FOR FREE LUNCH, 2010-2016
2010-11 2012-13 2013-14 2014-15 2015-2016
Region 10 68.5% 74.9% 75.1% 74.3% 73.8%
Brewster 51.3% 55.7% 53.8% 50.9% 50.6%
Culberson 73.9% 74.0% 73.0% 74.2% 74.3%
El Paso 68.7% 75.0% 75.2% 74.4% 73.8%
Hudspeth 84.1% 83.5% 87.2% 82.5% 86.0%
Jeff Davis 48.7% 49.2% 87.1% 52.3% 57.0%
Presidio 54.5% 84.8% 84.1% 84.8% 89.6%
Texas 50.2% 60.2% 60.0% 58.7% 58.9%
United States 48.1% 51.3% 51.9% 51.8% 52.6% * Participation data are nine-month averages; summer months (June-August) are excluded. Participation is based on average daily meals divided by an attendance factor of 0.927. Department of Defense activity represents children of armed forces personnel attending schools overseas. Data Source: National Center for Education Statistics, NCES - Common Core of Data. 2014-16.
2017 2016 2015 2014 Texas 1,668,798 1,631,721 1,585,089 1,463,495
Brewster 469 521 493 477
Culberson 206 209 208 203
El Paso 75,914 77,116 78,064 73,432
Hudspeth 377 378 334 313
Jeff Davis 65 73 65 60
Presidio 840 913 949 891
Data Source: Supplemental Nutritional Assistance Program (SNAP) Statistics. Texas Heath and Human Services Commission.
https://hhs.texas.gov/about-hhs/records-statistics/data-statistics/supplemental-nutritional-assistance-program-snap-statistics.
Accessed June 2018.
Accessed May 7 2018.
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TABLE 22 - NATIONAL SCHOOL LUNCH PROGRAM, 2017-2018
Data Source: National Assistance Program Report. March 2018 Summary. https://fns-prod.azureedge.net/sites/default/files/datastatistics/march-performance-report-2018.pdf. Accessed June 2018.
Environmental Risk Factors Prevention practitioners have long targeted risk and protective factors as the “influences of behavioral
health problems according to SAMHSA. A risk factor is a characteristic related to the individual’s
biological, psychological, family, community, or cultural level that precedes and is associated with a
higher likelihood of problem outcomes. Below are many of the factors that may influence an
individual’s likelihood to develop a substance abuse or related behavioral health problem.
Education Within the report area 81% of students are
receiving their high school diploma within four
years compared to 86.0% last year. Annual
dropout rates inform education professionals
about the numbers and rates of dropouts and
the reasons for dropping out. Dropout counts
and rates are often compared to measures of
graduation rate, such as a cohort graduation
rate. This indicator is relevant since research
suggests education is one the strongest
predictors of healthy behaviors and lower risk
for overall disease.
National Totals March 2017 Feb 2018 March 2018
Average Daily Participation (thousands) 30,049 29,796 29,700
Participating Children (Free/Reduced) 22,050 22,026 21,877
Percent Free/Reduced Price 73.38% 73.92% 73.66%
Total Snacks Served (in thousands) 24,827 21,243 21,973
Hispanic students accounted for the largest percentage of total enrollment in Texas public schools in 2016-17 (52.4%), followed by White (28.1%), African American (12.6%), Asian (4.2%), and multiracial (2.2%) students.
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Dropout Rates
El Paso Independent School District, Socorro Independent School District, and Ysleta Independent
School District are the largest districts in the region. Tables below show attendance rate, graduation
and dropout rate by county totals in Region 10.
TABLE 23 - TEXAS TOTAL ENROLLMENT, 2016-2017
Data Source: Texas Education Agency 2016-2017 Enrollment Summary Report. PEIMS Standard Reports Overview. https://fns-prod.azureedge.net/sites/default/files/datastatistics/march-performance-report-2018.pdf. Accessed June 2018.
TABLE 24 - REGION 10 ENROLLMENT, GRADUATION RATES AND DROPOUT RATES BY COUNTY, 2016-2017
Data Source: Texas Education Agency 2016-2017 Graduation/Dropout rate. PEIMS Standard Reports Overview. https://rptsvr1.tea.texas.gov/cgi/sas/broker. Accessed June 2018.
Ethnicity Student Count
Black or African American 674,718
American Indian or Alaska Native 20,767
Asian 225,294
Hispanic 2,809,386
Native Hawaiian/Other or Pacific Islander 7,700
Two or More Races 115,907
White 1,505,355
Total All Ethnicities 5,359,127
2016-2017 Graduation Rate
Dropout Rate
Brewster 98.8% 1.2%
Culberson 97.5% 2.5%
El Paso 95.7% 4.3%
Hudspeth 94% 2.0%
Jeff Davis 100% 0
Presidio 93.8% 3.1%
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TABLE 25 - REGION 10 ENROLLMENT, GRADUATION RATES AND DROPOUT RATES BY COUNTY, 2013-2015
Data Source: Texas Education Agency. Office of Academics Enrollment in Texas Public Schools Report 2012-2015.
Table 26-32 - Region 10 by County, 2016-2017 Enrollment
School Year
2013 2014 2015
Number of Students
Grad Rate
Dropout Rate
Number of Students
Grad Rate
Dropout Rate
Number of Students
Grad Rate
Drop-out Rate
Brewster 1264 100.0% 0.0% 1213 95.3% 3.5% 1171 97.2% 0.0%
Culberson 432 94.9% 5.1% 460 100.0% 0.0% 431 100.0% 0.0%
El Paso 34,235 83.6% 7.1% 34,778 83.4% 8.0% 35,601 84.2% 7.9%
Hudspeth 712 93.0% 7.0% 673 89.3% 8.9% 653 95.1% 2.4%
Jeff Davis 343 97.6% 2.4% 270 90.0% 3.3% 256 100.0% 0.0%
Presidio 1,772 86.5% 9.2% 1,761 89.8% 10.2% 1,726 90.7% 6.2%
Texas 5,151,925 88.0% 6.6% 5,232,065 88.3% 6.6% 5,299,728 89.0% 6.3%
Grade Level Student Count
Early Education 719
Pre-kindergarten 8,297
Kindergarten 11,496
Grade 1 12,366
Grade 2 12,701
Grade 3 13,003
Grade 4 13,143
Grade 5 12,964
Grade 6 12,883
Grade 7 13,189
Grade 8 12,929
Grade 9 15,026
Grade 10 14,105
Grade 11 13,054
Grade 12 12,530
Grade Level Student Count
Early Education 9
Pre-kindergarten 62
Kindergarten 81
Grade 1 104
Grade 2 98
Grade 3 100
Grade 4 96
Grade 5 116
Grade 6 91
Grade 7 105
Grade 8 106
Grade 9 95
Grade 10 96
Grade 11 90
Grade 12 76
El Paso County Brewster
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Data Source: Texas Education Agency 2016-2017 Enrollment Summary Report. PEIMS Standard Reports Overview.
https://rptsvr1.tea.texas.gov/cgi/sas/broker. Accessed June 2018.
Grade Level Student Count
Pre-kindergarten 25
Kindergarten 29
Grade 1 35
Grade 2 45
Grade 3 31
Grade 4 28
Grade 5 37
Grade 6 20
Grade 7 22
Grade 8 30
Grade 9 30
Grade 10 31
Grade 11 36
Grade 12 26
Grade Level Student Count
Early Education N/A
Pre-kindergarten 20
Kindergarten 44
Grade 1 39
Grade 2 48
Grade 3 36
Grade 4 43
Grade 5 42
Grade 6 39
Grade 7 51
Grade 8 50
Grade 9 48
Grade 10 50
Grade 11 49
Grade 12 44
Grade Level Student Count
Early Education N/A
Pre-kindergarten 10
Kindergarten 22
Grade 1 16
Grade 2 14
Grade 3 25
Grade 4 17
Grade 5 24
Grade 6 24
Grade 7 32
Grade 8 19
Grade 9 19
Grade 10 20
Grade 11 17
Grade 12 11
Grade Level Student Count
Pre-kindergarten 82
Kindergarten 117
Grade 1 103
Grade 2 107
Grade 3 114
Grade 4 129
Grade 5 104
Grade 6 126
Grade 7 126
Grade 8 150
Grade 9 142
Grade 10 145
Grade 11 123
Grade 12 133
Culberson Hudspeth
Jeff Davis Presidio
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School Discipline
The State of Texas is served by Education Service Centers geographically. The counties in Region 10
are served by Education Services Centers 18 and 19. The largest districts in El Paso County are served
by ESC 19.
The data derived for the Texas Education Agency provides insight to measurable outcomes attributed
to youth that are suspended, expelled and ultimately drop out. The data also helps to improve on
district operations which would affect the rates of crime and suspension overall.
Below the tables identify each school districts in Region 10 within Education Service Center 18 and 19
with totals of In School Suspension (ISS) and Disciplinary Alternative Education (DAEP) as reported by
the Texas Education Agency for the school year 2015-2016, 2016-2017.
TABLE 33 - REGION 10 (ESC 19) SCHOOL DISTRICT TOTALS FOR ISS AND DAEP, 2016-2017
Source: Texas Education Agency, Counts of Students and Actions by Discipline Action Reasons and discipline Action Groups Summary Report.
PEIMS Data 2016-2017. https://rptsvr1.tea.texas.gov/cgi/sas/broker. Accessed June 2018.
ESC 19
School Districts Region 10
Number of Students
ISS DAEP # of Violations possession of substance/drugs
El Paso Anthony ISD 926 96 14 0
Burnham Wood Charter School District
996 0 0 N/A
Canutillo ISD 6,379 676 95 N/A
Clint ISD 12,275 1,968 120 23
El Paso Academy 671 0 0 0
El Paso ISD 63,992 3,522 1,313 5
El Paso Leadership Academy 272 75 0 0
Fabens ISD 2,481 883 60 N/A
Harmony Science Academy 3,508 514 0 0
La Fe Preparatory School 287 0 0 0
Paso del Norte Academy Charter District
387 0 0 0
San Elizario ISD 4,203 521 119 N/A
Socorro ISD 48,835 5,171 624 189
Tornillo ISD 1,198 153 32 N/A
Vista del Futuro Charter School 373 0 0 0
Ysleta ISD 44,268 6,159 593 198
Hudspeth Dell City ISD 78 0 0 N/A
Ft. Hancock ISD 434 38 0 N/A
Sierra Blanca ISD 133 10 0 N/A
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TABLE 34 - REGION 10 (ESC 19) SCHOOL DISTRICT TOTALS FOR ISS AND DAEP, 2015-2016
Source: Texas Education Agency, Counts of Students and Actions by Discipline Action Reasons and discipline Action Groups
Summary Report PEIMS Data 2015-2016. https://rptsvr1.tea.texas.gov/cgi/sas. Accessed June 2018.
TABLE 35 - REGION 10 (ESC 18) SCHOOL DISTRICT TOTALS FOR ISS AND DAEP, 2016-2017
Source: Texas Education Agency Counts of Students and Actions by Discipline Action Reasons and discipline Action Groups
Summary Report PEIMS Data 2015-2016. https://rptsvr1.tea.texas.gov/cgi/sas. Accessed June 2018.
ESC 19
School Districts Region 10
Number of Students
ISS DAEP # of Violations possession of substance/drugs
El Paso Anthony ISD 838 70 8 6
Burnham Wood Charter School District
1,031 N/A N/A N/A
Canutillo ISD 5,973 730 148 46
Clint ISD 11,669 2,109 121 20
El Paso Academy 362 N/A N/A N/A
El Paso ISD 59,772 3,606 1439 348
El Paso Leadership Academy 181 33 N/A N/A
Fabens ISD 2,364 690 47 7
Harmony Science Academy 2,691 160 N/A N/A
La Fe Preparatory School 262 N/A N/A 6
Paso del Norte Academy Charter District
241 N/A N/A N/A
San Elizario ISD 3,955 318 71 17
Socorro ISD 45,126 5,013 494 191
Tornillo ISD 1,192 286 N/A N/A
Vista del Futuro Charter School 364 N/A N/A N/A
Ysleta ISD 42,232 5,750 511 240
Hudspeth Dell City ISD 82 N/A N/A N/A
Ft. Hancock ISD 434 47 N/A N/A
Sierra Blanca ISD 123 N/A N/A N/A
ESC 18
School Districts Region 10
Number of Students
ISS DAEP # of Violations possession of substance/drugs
Brewster Alpine ISD 1,213 110 18 0
Marathon ISD 73 0 0 0
San Vicente ISD 19 0 0 0
Terlingua CSD 114 9 0 0
Culberson Culberson County-Allamoor ISD 484 79 10 0
Jeff Davis Fort Davis ISD 258 15 0 0
Valentine ISD 48 0 0 0
Presidio Marfa ISD 376 0 0 0
Presidio ISD 1,446 29 41 0
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TABLE 36 - REGION 10 (ESC 18) SCHOOL DISTRICT TOTALS FOR ISS AND DAEP, 2015-2016
Data Source: Texas Education Agency PEIMS District Level Annual Discipline Summary 2015-2016. https://rptsvr1.tea.texas.gov/cgi/sas/broker. Accessed June 2018.
Criminal Activity Violence and injury prevention can encompass a variety of topics. Many injuries include those that are
purposely inflicted with the intent of injuring someone. Examples of these include violent crimes and
physical abuse. The information is important in understanding the types of activities that can erode a
community. In most cases where there is an appropriate public health approach to the problem, the
majority of these events can be prevented.
The following data are areas of focus for this assessment and are not inclusive of all crime statistics for
Region 10.
The Federal Bureau of Investigation (FBI) crime reporting program, defines violent crime as an offense
which involves force or threat of force. The following crime index are based on available data for
Region 10, Texas and national databases. Note: Each county is served by a law enforcement
jurisdiction. The table below outlines the county with the corresponding jurisdiction. Law enforcement
data reports currently available for each, include violent crime and property crime by county. Note: As
of the publication of this year’s RNA the data for year 2017-2018 Uniform Crime Reporting data was not
yet available.
ESC 18
School Districts Region 10
Number of Students
ISS DAEP # of Violations possession of substance/drugs
Brewster Alpine ISD 1,079 96 27 0
Marathon ISD 54 0 0 0
San Vicente ISD 31 0 0 0
Terlingua CSD 86 0 0 0
Culberson Culberson County-Allamoor ISD 436 108 8 0
Jeff Davis Fort Davis ISD 228 0 0 0
Valentine ISD 46 0 0 0
Presidio Marfa ISD 360 30 0 0
Presidio ISD 1,366 29 26 0
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TABLE 37 - JURISDICTIONAL LAW ENFORCEMENT BY COUNTY FOR REGION 10
Data Source: Texas Crime Summary Report. Chapter 10A 2018. Accessed March 10 2018.
TABLE 38 - STATE OF TEXAS TOTAL REPORTED CRIME, 2015-2016
Offenses 2015 2016 % Change
Murder 1,314 1473 12.1%
Rape 12,208 13,320 9.1%
Robbery 31,883 33,250 4.3%
Aggravated Assault 67,358 72,609 7.8%
Burglary 152,444 149,073 -2.9%
Larceny-Theft 555,867 548,941 -1.2%
Motor Vehicle Theft 67,081 68,523 2.1%
Total 888,155 886,189 -0.2%
Data Source: Texas Crime Summary Report Chapter 2 2016. Published February 2018. https://www.dps.texas.gov/crimereports/16/citCh2.pdf. Accessed May 21 2018.
Police Department Sherriff’s Office School District PD
Brewster Alpine PD Sul Ross PD
Brewster County SO
Culberson
Culberson County
SO
El Paso
Anthony PD El Paso PD
UT El Paso PD EPCC PD Clint PD
Horizon PD Socorro City PD
El Paso County SO
El Paso ISD PD Socorro ISD
Hudspeth
Hudspeth County
SO
Jeff Davis
Jeff Davis County
SO
Presidio
Marfa PD
Presidio PD
Presidio County SO
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TABLE 39 - STATE OF TEXAS TOTAL REPORTED CRIME, 2014-2015
Offenses 2015 2014 % Change
Murder 1,314 1,187 10.7
Rape 12,208 11,466 6.5
Robbery 31,883 30,857 3.3
Aggravated Assault 67,358 65,338 3.1
Burglary 152,444 166,429 -8.4
Larceny-Theft 555,867 570,385 -2.5
Motor Vehicle Theft 67,081 67,741 -1.0
Total 888,155 913,403 -2.8
Data Source: Texas Crime Summary Report. Chapter 10A. 2015.
Property Crime
TABLE 40 - INDEX VIOLENT AND PROPERTY CRIME BY COUNTY, 2016
Murder Rape Robbery Aggravated assault
Burglary Larceny-theft
Motor vehicle
theft
Total Offenses
Brewster 0 2 0 4 15 19 1 41
Culberson 0 0 2 3 0 0 0 5
El Paso 23 378 520 2134 1781 11,656 928 17,420
Hudspeth 0 0 0 0 0 0 1 1
Jeff Davis 0 1 0 1 2 0 0 4
Presidio 0 0 0 0 0 0 3 3
Data Source: Texas Crime Summary Report Chapter 10b County-Level Violent and Property Crime 2018.
https://www.dps.texas.gov/administration/crime_records/pages/crimestatistics.htm. Accessed June 2018.
TABLE 41 - INDEX VIOLENT AND PROPERTY CRIME BY COUNTY, 2015
Murder Rape Robbery Aggravated assault
Burglary Larceny-theft
Motor vehicle theft
Total Offenses
Brewster 1 2 0 8 35 88 7 141
Culberson 0 0 0 1 3 2 0 7
El Paso 23 370 444 2,128 1,851 12,552 947 18,315
Hudspeth 0 0 0 1 11 15 0 27
Jeff Davis 1 0 0 3 6 1 13 24
Presidio 0 2 0 8 9 24 11 54 Data Source: Texas Crime Summary Report Chapter 10b. County-Level Violent and Property Crime 2017. Accessed June 2018.
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Family Violence and Child Abuse
The National Coalition against Domestic Violence (NCADV) reports on average nearly 20 people per
minute are physically abused by an intimate partner in the United States. During one year, this would
equate to more than 10 million women and men. In Texas, data collected for 2016 found 146 women
killed by a male intimate partner, compared to 2015 date where 158 women were killed. The county
with the highest number of deaths in Region 10 was El Paso with 2 deaths, followed by Culberson
County with 1 death in 2016 related to family violence.
The total number of Texas family violence incidents in 2016 was 196,564. This represented a 0.9 %
increase when compared to 2015. These incidents involved 214,815 victims (up 1.7 percent from 2015)
and 208,764 offenders (up 1.8 percent from 2015).
TABLE 42 - FAMILY VIOLENCE IN TEXAS, 2016
Data Source: Texas Crime Summary Report Chapter 5 Family Violence 2016. http://www.dps.texas.gov/crimereports/16/citCh5.pdf. Accessed June 2018.
2016 2015 % change
Incidents 196,564 194,872 0.9%
Victims 214,815 211,301 1.7%
Offenders 208,764 2015,154 1.8%
Data Source: Texas Council on Family Violence 2016 Honoring Texas Victims Summary.
http://2mg7g749lu2112sis323nkkn.wpengine.netdna-cdn.com/wp-content/uploads/2017/10/2016_HTV_Fact_Sheet.pdf.
Accessed June 2018.
Figure 9. State of Texas Summary, Intimate Partner - By the numbers 2016 Facts and Figures
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TABLE 43 - FAMILY VIOLENCE NUMBER OF INCIDENTS BY COUNTY, 2014-2016
Data Source: Texas Crime Summary Report, Chapter 5, Family Violence, 2016, accessed June 20, 2018, http://www.dps.texas.gov/crimereports/16/citCh5.pdf
Drug Seizures/Trafficking Arrests
Texas shares its 1,254-mile border with Mexico that follows the course of the Rio Grande River. The border area and its expansive geographical terrain make it difficult for law enforcement agencies to continuously monitor the areas used by drug traffickers to smuggle illicit drugs into the United States. Significant quantities of heroin, cocaine, marijuana and methamphetamines are smuggled from Mexico into Texas. Data from the Federal-wide Drug Seizure System (FDSS) indicates large quantities of drugs seized by federal law enforcement in Texas, most of which is seized near the U.S.-Mexico border, more than any other state in the United States. The DEA reports Region 10 as geographically centered for 8 different drug trafficking corridors. A 2017
Department of Public Safety Report reveals marijuana to be the most commonly used and most widely available illicit drug in the U.S. Reports for Region 10 from different law enforcement agencies also report marijuana and methamphetamine as the most trafficked drugs for this area.
“Between 2014 and 2016, there has been a 103% increase in methamphetamine seizures on the border.
In addition, the El Paso Intelligence Center (EPIC) predicts a possible correlation between heroin and
methamphetamine seizures as Mexican transnational criminal organizations (TCOs) and drug
trafficking organizations (DTOs) actively pursue new user markets and expand into supplemental
product lines to ensure their operating costs remain low and their profit margins remain high.
According to the DEA, Mexican DTOs/TCOs have been switching their focus from methamphetamine
to heroin primarily as a result of the current low price of methamphetamine in the United States. This
has enabled the Mexican DTOs/TCOs to explore product diversification and new market areas where
methamphetamine is not widely used in the United States. This diversification can be seen in the fact
that 17% of the methamphetamine deaths in 2016 in Texas also involved heroin16.”
16 Substance Abuse Trends in Texas 2017, a Report to the National Drug Early Warning System, Jane Carlisle Maxwell, Ph.D.
County
# of incidents, 2014
# of incidents, 2015
# of incidents 2016
Brewster 33 34 41
Culberson 2 3 9
El Paso 5,501 5,391 5,059
Hudspeth 5 2 3
Jeff Davis 4 7 0
Presidio 7 3 1
Photo Credit: Drug seizure
Navarro County, Texas,
Sherriff’s Office.
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TABLE 44 - DEA STATE OF TEXAS DRUG SEIZURES, 2016
* The Drug Enforcement Administration keeps a record of controlled substances taken into federal custody. This
record includes all drugs submitted to the DEA’s laboratory system for analysis.
Data Source: Drug Enforcement Administration DEA Drug Seizure Data. Published January 2017.
https://www.dea.gov/resource-center/stride-data.shtml. Accessed July 2018.
West Texas HIDTA Drug Prices
Type of Drug & Quantity El Paso Midland/
Odessa
Alpine/ Marfa Las Cruces, NM
Marijuana (pound)
Cocaine (kilo)
Methamphetamine
Heroin
Hydrocodone (pill)
Type of Drug & Quantity Number of seizures
Average potency of
drug
Net Grams USD Value
Cocaine 408 77% 221,572.832 $6,560.00
Heroin 18 85% 15,755.16 $1,500.00
Methamphetamine 101 98% 271,486.14 N/A
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TABLE 45 - TYPE AND QUANTITY OF DRUGS SEIZED PER UNITS FOR EACH COUNTY IN REGION 10, 2014-2016
Data Source: Texas Department of Public Safety’s Uniform Crime Report. Drug seizure data 2014-2016. Accessed June 2018.
Caveat for 2016 data: 2016 data may possibly contain incomplete Drug Seizure data for incident-based reporting agencies. Every effort has been made to include all Drug Seizure data, but since the data is not technically complete, there is a possibility of the numbers changing by the
time of the Crime in Texas publication.
TABLE 46 - ARRESTS FOR DRUG ABUSE VIOLATIONS, PERCENT DISTRIBUTION BY U.S. REGION, 2017
*Because of rounding, the percentages may not add up to 100.0%.
**Region 10 is considered part of the South on a U.S. map.
Data Source: Federal Bureau of Investigation Crime in the United States summary report 2015. https://ucr.fbi.gov/crime-in-the-u.s/2015/crime-in-the-u.s.-
2015/tables/arrest_table_arrests_for_drug_abuse_violations_percent_distribution_by_regions_2015.xls. Accessed July 2018.
2014 2015 2016
Marijuana Opiates Other drugs
Marijuana Opiates Other drugs
Marijuana Opiates Other Drugs
Brewster 767 lbs. 2 oz. 9 gm 487 lbs. 13 oz. 21,462 liquid oz.
3,296 lbs. 18 gm 284 oz.
Culberson 10 oz. 5 lbs. 0 6 lbs. 0 6 grams 2 lbs. 5 gm 10 gm
El Paso 30,088 lbs. 766 lbs. 2,145 lbs.
21,543 lbs. 71 lbs. 128 lbs. 13,299 lbs. 132 lbs. 131 lbs.
Hudspeth 1,434 lbs. 190 dose units
3 lbs. 30 lbs. 0 36 dose units
763 lbs. 0 0
Jeff Davis 0 0 0 0 0 0 0 0 0
Presidio 56 lbs. 5 gm 0 535 lbs. 0 4 gm 151 lbs. 1 gm 1 oz.
Drug abuse violations
United States total
Northeast
Midwest South West
Total1 100% 100% 100% 100% 100%
Sale/Manufacturing: Total 16.1 19.9 15.9 16.6 13.4
Heroin or cocaine and their derivatives
5.5 10.9 3.7 5.1 4.0
Marijuana 4.6 5.2 6.3 4.0 3.7
Synthetic or manufactured drugs
1.8 1.5 1.1 3.4 0.5
Other dangerous nonnarcotic drugs
4.2 2.3 4.7 4.1 5.2
Possession: Total 83.9 80.1 84.1 83.4 86.6
Heroin or cocaine and their derivatives
19.9 18.0 10.9 14.7 33.5
Marijuana 38.6 46.1 50.7 46.5 16.5
Synthetic or manufactured drugs
5.1 3.5 5.2 7.6 2.8
Other dangerous nonnarcotic drugs
20.2 12.6 17.3 14.7 33.8
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TABLE 47 - U.S. BORDER PATROL NATIONWIDE CHECKPOINT DRUG SEIZURES IN POUNDS
*weights are in pounds (lb.). ** Fentanyl statistics reflected here are through April 30.
Data Source: U.S. Customs and Border Protection Enforcement Statistics.
https://www.cbp.gov/newsroom/stats/cbp-enforcement-statistics. Accessed July 2018.
TABLE 48 - U.S. BORDER PATROL DRUG SEIZURES, 2012-2018
FY2012 FY2013 FY2014 FY2015 FY2016 FY2017 FY2018TD
Cocaine 12,161 4,696 4,554 11,220 5,473 9,346 5,321
Heroin 430 576 606 518 566 953 315
Marijuana 2,299,864 2,430,123 1,922,545 1,538,307 1,294,052 861,231 360,241
Methamphetamine 3,715 3,580 3,930 6,443 8,224 10,328 7,205
Fentanyl n/a n/a n/a n/a n/a 181 309
*weights are in pounds (lb.). ** TD data is through May 2018.
Data Source: U.S. Customs and Border Protection Enforcement Statistics.
https://www.cbp.gov/newsroom/stats/cbp-enforcement-statistics. Accessed July 2018.
TABLE 49 - TYPE AND QUANTITY OF DRUG SEIZED BY COUNTY, 2018
Data Source: Texas Department of Public Safety Type and Quantity of Drugs seized January 2017 - June 2018.
https://txucr.nibrs.com/Report/DrugSeized. Accessed July 2018.
Totals in pounds Cocaine Heroin Marijuana Methamphetamine Fentanyl
April 2018 2,779.90 316.05 7.62 650.70 1.41
May 2018 2,296.16 225.95 40.40 668.83 14.09
FY 2018 39,510 3,316 206,883 45,896 **984
FY 2017 56,729 3,626 338,676 44,065 951.54
County Cocaine Opiates (Heroin) Marijuana Methamphetamine Clandestine labs Other
Brewster 8 grams 20 grams (O) 1,865 lbs. n/a n/a 53 grams
Hashish
Culberson n/a n/a 38 oz. 3 grams n/a n/a
El Paso 266 lbs. 270 lbs. (O) 8,637 lbs. 299 lbs. 3 (PCP)
6 (THC)
7,595 oz.
Hashish
Hudspeth 69 lbs. 28 lbs. (O) 2,710 lbs. 70 lbs. n/a 595 lbs.
Hashish
28 lbs.
Mushrooms
Jeff Davis n/a n/a n/a n/a n/a n/a
Presidio 3 grams 2 oz. (O) 2,559 lbs. n/a n/a 12 grams
Mushrooms
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Mental Health
Mental and substance use disorders impact the health of many individuals, which includes their
families, and community. The Substance Abuse and Mental Health Services Administration Survey on
Drug Use and Health, found more than 43.6 million or (18.1%) of Americans age 18 or older experience
some more of mental illness. Last year SAMHSA reported 20.2 million (8.4%) adults had some type of
substance use disorder, and of these same individuals, 7.9 million had both a mental disorder and a
substance use disorder combined. Mental illness is more prevalent among women (21.2%) than men
(14.3%), and occurred among more than a fifth of adults ages 18 to 25, as well over a fifth of adults ages
26 to 49.
Suicide
In both the United States and in Texas, suicide was the second leading cause of death for people
between the ages of 10-34 years of age. According to the Center for Disease Control and Prevention,
suicide is the 10th leading cause of death overall in the United States, claiming over 45,000 lives each
year17. It is always difficult to find accurate data on this indicator due to the differences of reporting by
agency, but for El Paso County, according to the El Paso Police Department, there has been an increase
of suicides from 2015 (70). Data from the Medical Examiner’s office as well as the West Texas Suicide
Prevention Coalition, report a combined total of 84 suicides for El Paso County for 2016. The data
below reflects the number of suicides by Region 10 counties up through 2017 as reported by the Texas
Health and Human Services Commission.
TABLE 50 - REGION 10 COUNTIES NUMBER OF SUICIDES, 2012-2017
Data Source: Texas Health Data, Death of Texas Residents 2012-2016. http://healthdata.dshs.texas.gov/VitalStatistics/Death. Accessed July 2018.
TABLE 51 - U.S. DATA, SUICIDE BY METHOD, 2016
Date Source: National Institute of Health Number of Suicides Deaths by Method Summary Report 2016. Accessed July 2018.
17 Center for Disease Control and Prevention, Suicide Prevention Health Information, last updated May 2018, accessed July 2018.
2012 2013 2014 2015 2016 2017
Brewster 2 0 2 0 0 0
Culberson 1 0 0 0 0 0
El Paso 62 79 90 69 84 78
Hudspeth 0 0 0 0 0 0
Jeff Davis 0 0 1 0 0 0
Presidio 0 0 2 0 0 0
Suicide Method Number of deaths
Total 44,965
Firearm 22,963
Suffocation 11,642
Poisoning 6,698
Other 3,662
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Adolescents and Adults Receiving Substance Abuse Treatment
Individuals with co-occurring mental and substance use disorders are a
population that experience greater challenges in treatment. Most
often many of those receiving treatment for both disorders are not
simultaneously integrated, with poorer outcomes. A study by the
National Survey on Drug Use and Health based on data collected from
2008-2014, found 3% of the U.S. population suffer from both a mental
health and substance use disorder, and fewer than 10% received
treatment for both disorders. Below are 2017 data related to adult,
youth and adolescents identified with mental health and substance use
issues.
TABLE 52 - REGION 10, YOUTH AND ADOLESCENTS MENTAL HEALTH CLIENTS, AGES 6-17, 2017
Region 2017 # of Clients 2017 % of Clients 2016 # of Clients 2016 % of Clients
10 1754 2.52% 1528 2.38%
Date Source: Health and Human Services. Office of Decision Support HHSC funded substance abuse treatment adolescent admission data. Accessed July 2018.
Table 53 - Region 10, Mental Health/Substance Use among Adolescents Clients, Ages 6-17, 2017
Region MH/SUD
Indicator
2017 # of
Clients
2017 % of
Clients
2016 # of
Clients
2016 % of
Clients
10 MH Only 1656 94.41% 1433 93.78%
10 Dual Diagnosis 98 5.59% 95 6.22%
Data Source: Health and Human Services. Office of Decision Support HHSC funded substance abuse treatment adolescent
admission data. Accessed July 2018.
Table 54 - Region 10, Mental Health/Substance Use among Adolescents Clients, Ages 6-17, 2017
Data Source: Health and Human Services. Office of Decision Support HHSC funded substance abuse treatment adolescent
admission data. Accessed July 2018.
Calendar Year
County Name # Clients
2017 Brewster 18
2017 Culberson *
2017 El Paso 1,695
2017 Hudspeth *
2017 Jeff Davis *
2017 Presidio 27
Photo Credit: SAMHSA, Shutterstock.
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TABLE 55 - REGION 10, ADULT MENTAL HEALTH ADMISSIONS, 2017
Primary Diagnosis 2017 # of Clients
Region 10 1739
Adjustments / Other non-psychotic 69
Affective disorders - Bipolar 43
Affective disorders - Major depression 380
Affective disorders - Other 137
Anxiety / Somatoform / Dissociative 62
Attention Deficit Disorder 600
Autism / Pervasive Disorders *
Dementia / Other cognitive disorders *
Disruptive Behavior Disorder 45
Drug Related disorders *
Not Applicable 145
Other Developmental / Behavioral *
Other psychoses 14
Personality / Factitious / Impulse *
Schizophrenia and related disorders *
Undiagnosed Mental Health 244 Data Source: Health and Human Services Office of Decision Support. Mental Health Admissions
For Region 10. Accessed June 2018. Depression
The following table has information on the total amount of Medicare beneficiaries with depression as of
2015 (most recent data available). The lowest percentage of Medicare Beneficiaries with depression is
from Jeff Davis County (7.07%) and the highest percentage is in El Paso County (14.02%). The
percentage of people diagnosed with clinical depression in Texas is (17.0%) and in the United States
(16.7%). Data from Medicare Designated Beneficiaries reported El Paso individuals under with age of
65 with a 3.3% prevalence for Alzheimer’s Disease/Dementia, 23.5% for Depression, and 6.9%
Schizophrenia and other psychotic disorders prevalence.
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TABLE 56 - REGION 10, MENTAL HEALTH BENEFICIARIES ADMISSIONS, 2015
Date Source: Centers for Medicare and Medicaid Services, Chronic Conditions Measure through Administrative claims report
summary, last updated March 2017, Data years 2007-2015, accessed July 2018, https://www.cms.gov/Research-Statistics-
Data-and-Systems/Statistics-Trends-and-Reports/Chronic-Conditions/CC_Main.html
Date Source: Centers for Medicare and Medicaid Services, Chronic Conditions Measure through Administrative
claims report summary, last updated March 2017, Data years 2007-2015, accessed July 2018, https://www.cms.gov/Research-
Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Chronic-Conditions/CC_Main.html.
Total Medicare
Beneficiaries
Beneficiaries with
Depression
Percent with
Depression
Brewster 1,385 136 9.8%
Culberson 364 44 19.5%
El Paso 45,790 6,484 14.02%
Hudspeth 331 36 13.3%
Jeff Davis 466 33 7.07%
Presidio 1,362 129 9.5%
Region 10 49,698 6,900 13.9%
Texas 2,215,695 377,096 17.0%%
United States 34,118,227 5,695,629 16.7%%
Estimated population
Number of Mental Health Providers
Mental Health Provider rate (per
100,000 population)
Brewster 9,173 136 130.8
Culberson No data 0 No data
El Paso 833,437 67 80
Hudspeth 0 0 No data
Jeff Davis 2,204 4 181.4
Presidio 6,978 1 14.3
Region 10 851,793 684 80.3
Texas 26,667,264 377,096 102.3
United States
317,105,555 643,219 202.8
TABLE 57 - REGION 10 ACCESS TO MENTAL HEALTH PROVIDERS, 2015
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Social Factors There are a number of factors that can influence the likelihood of an individual using substances such as
biological and psychological characteristics. An individual may come across specific risk factors in their
life that can include norms and laws favorable to substance use, much like the misinformation may
individuals have on synthetic marijuana and vaping.
Research has increasingly shown how strongly social and economic conditions determine an
individual’s health and differences in health among subgroups, much more so than medical care. An
example, research has shown that poverty in childhood has long lasting effects, which in turns limits life
expectancy and overall worsening health conditions if the conditions were not improved.
Social Norms of Substance Consumption
The following section focuses on data regarding youth and adult perception of harm across substances
and health behaviors.
The data from the Texas School Survey of Drug and Alcohol Use collects self-reported tobacco,
alcohol, and substance use data from students in grades 7 through 12 in Texas public schools. The
survey is sponsored by the Texas Health and Human Services Commission (HHSC) and administered by
the Public Policy Research Institute (PPRI). The data charts and figures below are from the data
collected in 2016, analyzed and reported through 2018. Note: Data from the schools that participated
from Region 10 are included in the aggregate data unless otherwise designated.
Data Source: Texas State School Survey Summaries and Report. Published April 2018.
http://texasschoolsurvey.org/Report#D. Accessed July 2018.
Table 59 - Prevalence of past 30 day Alcohol Use among Students, TEXAS SCHOOL SURVEY
EL PASO REGION PARTICIPATING SCHOOLS, N=3,666
*grades with N/A did not complete the survey or the school is a middle school vs. a high school
Data Source: Texas State School Survey School A-E Executive Summary. Published April 2018.
http://texasschoolsurvey.org/SchoolSummary. Accessed July 2018.
How Do Your Parents Feel About Kids Your Age Drinking Alcohol, Grades 7-12
Region Strongly
Disapprove Mildly
Disapprove Neither Mildly
Approve Strongly Approve
Do Not Know
10 66.8% 12.8% 9.4% 3.6% 1.1% 6.3%
El Paso Schools Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade 12
School A n/a n/a 25.4% 39.4% 48.9% 53.7%
School B 8.8% 21.4% n/a n/a n/a n/a
School C 22.3% n/a n/a n/a n/a n/a
School D n/a n/a 38.5% 36.1% 47.9% 56.7%
School E n/a n/a 30.5% 41.1% 39.4% 38.9%
TABLE 58 - YOUTH PERCEPTION OF PARENTAL APPROVAL OF CONSUMPTION AND ACCESS, TEXAS SCHOOL SURVEY, 2016
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Another measure of alcohol use among youth is the Texas Youth Risk Behavior Surveillance System
(YRBSS) which has collected data since it’s initiation in 1991. The YRBSS is a federally funded
classroom-based paper survey conducted biennially on odd years. The survey measures priority health-
risk behaviors that can contribute substantially to the leading causes of death, disability, and social
problems among youth and adults in the United States. The data from the survey is a useful tool to
monitor the Healthy People 2020 Objectives for smoking, overweight, exercise, seat belt use,
fruit/vegetable consumption, alcohol consumption, drug use, sexual activity and other risk factors.
Data from the most recent survey results from 2017 are below.
Table 60 - Texas High School Youth Risk Behavior Survey, Alcohol use Among High School
Students, 2017
*N/A indicates data not supported
Data Source: Texas Department of State Health Services. 2001-2017 High School Youth Risk Behavior Survey Data. http://healthdata.dshs.texas.gov/healthrisks/YRBS/. Accessed April 2018.
Peer Approval/Consumption
Perception of one’s peers and parental views on substance use can be quite influential on an individual’s
proclivity to do the same. Despite the increase of peer influences along with social media access, as
children age, parents continue to be an important part in shaping alcohol and substance use among
adolescents. Parents who actively monitor their children’s use and have house rules regarding alcohol
use, are less likely to have adolescents who drink or begin drinking at an earlier age. Below are data
regarding parents and student perception in the use of alcohol, tobacco and marijuana.
Current Past
Month Drinking
Drank Before Age 13
Binge Drinking
Access from
someone else
9th grade 20.5% 19.7% 6.1% 46.7%
10th grade 21.7% 16.6% 7.9% n/a
11th grade 30.1% 13.3% 13.9% 44.6%
12th grade 36.9% 17.1% 21.8% 39.5%
State Total 26.8% 16.9% 11.8% n/a
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Data Source: Texas State School Survey Border Report. Published April 2018. http://www.texasschoolsurvey.org/Report#C. Accessed July 2018.
Data Source: Texas State School Survey Border Report. Published April 2018. http://www.texasschoolsurvey.org/Report#C.
Accessed July 2018.
Table 61 - TSS Border Regions Report, perception on tobacco use, Grades 7-12, 2016
How many of your close friends use tobacco?
Southwest Border Region 7th grade 8th grade 9th grade 10th grade 11th grade 12th grade
None 86.6% 81.4% 72.1% 67.0% 62.8% 54.1%
A few 9.7% 12.7% 17.7% 20.0% 22.7% 25.6%
Some 2.7% 4.0% 6.6% 8.9% 9.2% 12.8%
Most 0.6% 1.3% 2.8 3.4% 4.4% 5.6%
All 0.5% 0.6% 0.8 0.7% 0.8% 1.9% Data Source: Texas State School Survey Border Report. Published April 2018.
http://www.texasschoolsurvey.org/Report#C. Accessed July 2018.
Table 62 - TSS Border Regions Report, perception of peer consumption of alcohol, Grades 7-12, 2016
How many of your close friends use alcohol?
Southwest Border Region 7th grade 8th grade 9th grade 10th grade 11th grade 12th grade
None 77.5% 63.9% 43.7% 39.7% 34.1% 28.5%
A few 14.2% 20.3% 26.2% 26.7% 28.1% 28.1%
Some 5.6% 9.7% 18.0% 17.7% 19.4% 19.0%
Most 2.1% 4.5% 9.7% 11.7% 14.3% 17.1%
All 0.6% 1.6% 2.4% 4.2% 4.0% 7.3%
Table 63 - TSS Border Regions Report, perception on marijuana use, Grades 7-12, 2016 How many of your close friends use marijuana?
Southwest Border Region 7th grade 8th grade 9th grade 10th grade 11th grade 12th grade
None 81.3% 69.2% 56.7% 47.6% 46.3% 42.9%
A few 11.3% 16.2% 20.7% 23.7% 23.2% 23.5%
Some 4.6% 7.0% 10.7% 14.5% 15.4% 14.9%
Most 1.7% 5.0% 8.3% 10.7% 12.0% 12.3%
All 1.1% 2.5% 3.5% 3.5% 3.1% 6.4%
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Parental Approval/Consumption
Data Source: Texas State School Survey Border Report. Published April 2018. http://www.texasschoolsurvey.org/Report#C, Accessed July 2018.
Data Source: Texas State School Survey Border Report. Published April 2018. http://www.texasschoolsurvey.org/Report#C. Accessed July 2018.
Table 64 - TSS Border Regions Report, parent perception on the use of tobacco, Grades 7-12, 2016
How do your parents feel about kids your age using tobacco?
Southwest Border Region 7th grade 8th grade 9th grade 10th grade 11th grade 12th grade
Strongly Disapprove 80.8% 82.1% 79.7% 81.3% 79.6% 75.3%
Mildly disapprove 2.6% 4.7% 6.6% 6.1% 7.1% 8.4%
Neither 1.7% 2.8% 4.3% 4.0% 4.2% 6.9%
Mildly Approve 0.6% 0.5% 0.6% 1.0% 0.6% 2.1%
Strongly Approve 1.3% 0.6% 0.9% 0.9% 0.4% 1.0%
Do Not Know 12.9% 9.4% 7.9% 6.7% 8.1% 6.3%
Table 65 - TSS Border Regions Report, parent perception on the consumption of alcohol, Grades 7-12, 2016
How do your parents feel about kids your age drinking alcohol?
Southwest Border Region
7th grade 8th grade 9th grade 10th grade 11th grade 12th grade
Strongly disapprove 75.2% 73.4% 64.2% 66.8% 66.5% 60.9%
Mildly disapprove 6.5 8.7 14.5 12.8 12.5 14.7
Neither 3.1 5.8 9.8 9.4 10.5 11.5
Mildly approve 1.6 2.0 3.4 3.6 2.7 5.0
Strongly approve 1.4 0.8 1.2 1.1 0.8 1.9
Do not know 12.3 9.3 6.9 6.3 7.0 6.0
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Data Source: Texas State School Survey Border Report. Published April 2018 http://www.texasschoolsurvey.org/Report#C. Accessed July 2018.
Adolescent Sexual Behavior
Although teen pregnancy may or may not be contributed to substance abuse, it is important to
understand that it may increase a teen parents’ risk factors.
The teen birth data is from the County Health Rankings & Roadmaps with the number of births per
1,000 females between the ages of 15 and 19. The birth rate of Culberson, El Paso, Hudspeth, and
Presidio are higher than in Texas (31) based on the total female population age 15-19.
Table 67 - Region 10, Teen Pregnancy Rate
*Teen Birth Rate = births per 1,000 girls Teen births. County Health Rankings & Roadmaps. http://www.countyhealthrankings.org/app/texas/2018/measure/factors/14/data?sort=sc-0.
Accessed June 6, 2018.
“In 2016 there were 29,765 teen births. Most teen births in Texas (77%) are to older teens
(age 18-19). It is also the case that 16% of all teen births were to teens who already had a child. The
public savings in 2015 due to declines in the teen birth rate totaled $418 million. Teen birth rates
have fallen for all racial and ethnic groups, and in some cases the gap in teen birth rates by
race/ethnicity has narrowed, but disparities remain.”18
18 Centers for Disease Control and Prevention (CDC). (2016). Natality Public -Use Data on CDC Wonder Online Database.
https://wonder.cdc.gov/natality.html. Last accessed July 2018.
Table 66 - TSS Border Regions Report, parent perception on the use of marijuana, Grades 7-12, 2016
How do your parents feel about kids your age using marijuana?
Southwest Border Region
7th grade 8th grade 9th grade 10th grade 11th grade 12th grade
Strongly disapprove 80.8% 81.7% 79.6% 78.8% 79.1% 77.1%
Mildly disapprove 2.2 3.2 5.8 5.8 6.3 6.6
Neither 1.8 3.6 5.1 5.0 5.5 7.3
Mildly approve 0.7 0.7 1.3 2.1 1.2 1.8
Strongly approve 1.6 1.3 1.5 1.7 1.0 1.5
Do not know 12.9 9.4 6.6 6.5 6.9 5.6
County Teen Birth Rate (2010-2016) Ranking
Presidio 76 15
Culberson 71 28
Hudspeth 65 42
El Paso 52 96
Jeff Davis 45 140
Brewster 37 182
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Cultural Norms and Substance Abuse
Cultural norms and sociocultural beliefs can shape behaviors regarding substance use and abuse.
Research has shown that culture plays a central role in forming the expectations of individuals about
potential problems they may face with drug use.
The degree of acculturation to which an individual identifies with his or her culture, is thought to be
related to substance use and abuse. Particularly for Region 10, Hispanic immigrants and Asian
immigrants live along the El Paso, Texas - Juarez, Mexico border as well as in Presidio, Texas - Ojinaga,
Mexico border.
Hispanics who have moved to the United States are said to have acute sensitivity to changes in the
degree of acculturation, often assume drinking behavior of the dominant society, therefore increasing
their use of alcohol.
Accessibility Perceived Access of Alcohol, Marijuana and Prescription Drugs
Alcohol use crosses ethnic, socio-economic, cultural and gender lines throughout the world. It is
commonly perceived as part of our American culture, particularly in the Hispanic culture at parties,
social functions and rites of passage. Teenagers often mimic the behaviors of adults, including the
coping methods of drinking and substance use. Teens are more often bombarded with alcohol,
tobacco and prescription medication advertisements. They listen to the radio and hear music
promoting drinking, with subliminal messages that may influence their behavior to experiment with
drugs and alcohol. Exposure to these substances is made even easier by accessibility and density of
package/liquor stores, gas stations that sell alcohol and tobacco products, and convenience stores on
every corner. With all the factors surrounding teens today and the stressors of school assimilation,
social media acceptance, and their overall physical body changes, more and more are trying alcohol,
tobacco and drugs at a much younger age and is becoming a common behavior. The data below is a
snapshot of the Texas Behavioral Survey in response to survey questions from students in grades 7-12
on alcohol, marijuana and prescription drugs.
Alcohol Alcohol enters the bloodstream from the initial drink
and has an immediate effect that can appear within
about 10 minutes. SAMHSA reports that slightly
more than half of Americans aged 12 or older as
being current drinkers of alcohol.
Alcohol is the most popular choice of substance
misuse for youth across the country, with more
adolescents consuming alcohol than those who
smoke cigarettes or use marijuana.
More adolescents consume alcohol during the school
year, more than any other time in the year. Smoking
Photo Credit: NIAAA, NIH, overview alcohol standard.
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tobacco has shown decreases over recent years, but the trend of novelty smoking products such as
juules and vaping have increased.
Four out of the six counties in Region 10 ranked among the top 30% of counties with the most alcohol
consumption. This is also reflected in region 10 for the average expenditures in alcohol ($851.30) and
percentage of at home expenditures (15.04%), which is higher than in the average in Texas and the U.S.
Past Month School Year Ever Used Never Used
Texas 28.6% 34.0% 53.0% 47.0%
Region 10 34.7% 40.4% 58.6% 41.4% Data Source: Texas State School Survey of Drug and Alcohol Use, the Public Policy Research
Institute Texas A&M University, 2018
2016
Total
Population
Age 18+
Estimated Adults
Drinking
Excessively
Estimated Adults
Drinking
Excessively(Crude
Percentage)
Estimated Adults
Drinking
Excessively(Age-
Adjusted
Percentage)
Region 10 568,520 97,492 17.4% 16.9%
Brewster County 7,353 1,096 14.9% 13.8%
Culberson County 1,870 no data suppressed suppressed
El Paso County 549,476 95,059 17.3% 16.9%
Hudspeth County 2,379 1,337 56.2% 34.3%
Jeff Davis County 1,910 no data suppressed suppressed
Presidio County 5,532 no data suppressed suppressed
Texas 17,999,726 2,879,956 16.0% 15.8%
United States 232,556,016 38,248,349 16.4% 16.9%
County Health Rankings & Roadmaps. http://www.countyhealthrankings.org/app/texas/2018/measure/factors/14/data?sort=sc-0. Accessed June 6 2018
TABLE 69 - REGION 10, ALCOHOL CONSUMPTION, BY COUNTY, 2016
TABLE 68 - REGION 10, ALCOHOL CONSUMPTION, GRADES 7-12, 2016 HOW RECENTLY, IF EVER, HAVE YOU USED ALCOHOL?
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TABLE 70- REGION 10, NUMBER OF ALCOHOL PERMITS ISSUED, 2017
TABLE 71- REGION 10, NUMBER OF ALCOHOL ESTABLISHMENTS, 2018
County Number of Alcohol Permits
Brewster 75
Culberson 20
El Paso 1542
Hudspeth 7
Jeff Davis 6
Presidio 41
Total population
Number of alcohol
retail establishments
Brewster 9,232 11
Culberson 2,398 2
El Paso 800,647 1,218
Hudspeth 3,476 0
Jeff Davis 2,342 1
Presidio 7,818 7
Data Source: US Census Bureau County Business Patterns.
https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ECN_200
US_42A1&prodType=table. Accessed July 2018.
Data Source: Texas Alcoholic Beverage Commission. Number of alcohol permits/licenses per county. http://ftp.tabc.texas.gov/Rosters/ByAddr/. Accessed July 2018.
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Alcohol Retail Permit Density (the number of alcohol outlets in a given location)
To reduce the risk of alcohol problems, limiting the number of alcohol outlets in relation to the
population in communities shapes the overall alcohol environment. Region 10 has a very active Alcohol
Impact Network, comprised of prevention providers, business owners, community organizations and
coalitions focused on reducing the risk of alcohol related negative consequences. The Alcohol Impact
Network relies on the data collection regarding retail outlets, in comparison to the number of calls for
service to the El Paso Police Department in addressing policy changes. The results of their work will be
published in 2018 and provides a clear correlation to the harms and negative consequences in the
consumption of alcohol in relation to disturbance calls. The information derived from the study
found over 1218 alcohol outlets, including 520 off-premise and 698 on premise locations within the
El Paso city limits19.
Below is a brief excerpt from the study regarding alcohol sales in El Paso, Texas:
“Total bar sales and alcohol outlets in El Paso almost doubled in the past 10 years, from $82 million in 2006
to $148 million in 2016, and from 624 alcohol outlets in 2006 to 1218 alcohol outlets in 2016. Alcohol
outlets are located through the city; however, some neighborhoods have more than others. With more
outlets come more complaints from residents about problems such as public intoxication, illegal parking,
litter, property damage and crime. Research studies have shown that a high concentration of alcohol
outlets in an area increases the likelihood of excessive alcohol consumption and alcohol-related harm.
A measure of vehicle crash deaths and motor vehicle crash deaths related to alcohol is also an
important indicator for creating prevention programming and examining alcohol policies for the safety
of communities. In 2016, there were 23,560 deaths in the United States due to alcohol, of those,
4,653 deaths involved motorcycle drivers, and 1,938 deaths involved pedestrians younger than age
16.20 Below is the most recent data regarding TABC permits and density for Region 10 counties. *2016-
2017 data will be released by the American Community Survey in December 2018.
19 Alcohol Impact Network, Paso del Norte Health Foundation, Alcohol Density Mapping Summary Report, via email dated June 26 2018. 20 Insurance Institute for Highway Safety Highway Loss Data Institute, Alcohol and Drugs 2016 Summary report, published December 2017,
accessed July 2018, www.iihs.org/iihs/topics/t/alcohol-and-drugs/fatalityfacts/alcohol-and-drugs/2016.
Number of
TABC Permits
Permits per sq. mile
(Density)
Brewster 66 0.11
Culberson 20 .005
El Paso 1,477 1.458
Hudspeth 9 .002
Jeff Davis 5 .002
Presidio 40 .002
TABLE 72 - REGION 10, TABC PERMITS AND DENSITY, 2015
Data Source: Texas Data Center.
TABC Alcoholic Beverage Permits.
Published March 2016. Accessed
July 2018.
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Sales Violations
In Region 10 El Paso County had the highest number of citations issued to retail establishments from
January 2017 - June 2018 (51) for Dispensing or Delivering Alcohol to a minor, Brewster County had (1)
citation while Culberson, Hudspeth, Jeff Davis and Presidio did not have citations during the same time
period.
Alcohol is the leading drug among young people in Region 10. According to the Texas State School
Survey more than 43% of 7-12th graders have ever used alcohol compared to any other substance use.
Among those who do drink alcohol, more than half said they have ridden in a car driven by someone
else who has been drinking. Youth and young adults are particularly vulnerable to alcohol related
consequences. Data from the Center for Disease Control and Prevention estimates the economic
burden of underage drinking, which includes healthcare, lost productivity, criminal justice and traffic
costs to be $1.8 billion per year in Texas (Paso del Norte Health Foundation, Underage Drinking Report,
2016).
Other Provision(s) Targeting Minors regarding alcohol offenses:
• Use of a false ID to obtain alcohol is a criminal offense.
• Penalty may include driver’s license suspension through a judicial procedure. Provisions Targeting
Retailers
• State provides incentives to retailers who use electronic scanners that read birthdate and other
information digitally encoded on valid identification cards.
• Licenses for drivers under age 21 are easily distinguishable from those for drivers age 21 and older.
• Specific affirmative defense—the retailer inspected the false ID and came to a reasonable conclusion
based on its appearance that it was valid21.
Social Hosting of Parties
A primary purpose of a Social Host Ordinance is to deter underage drinking parties where adults
knowingly allow minors to drink alcohol or alcoholic beverages. The ordinance applies to any adult who
is over the age of 18 and knowingly allows the consumption of alcohol by a minor.
The City of El Paso in Region 10 was the first city in Texas to pass a Social Host Ordinance on December
6, 2017. The implementation of the ordinance went into effect 90 days later. Currently there have been
approximately 21 citations issued for violation of the ordinance. The community partners of El Paso,
located in Region 10 worked alongside the Alcohol Impact Network over 22 months in researching,
analyzing and creating an ordinance that would be enforceable and effective. El Paso City Council
passed the ordinance that would in effect provide the El Paso Police Department another tool to
effectively address social hosting of underage drinking parties, by then reducing the negative
consequences associated with them.
21 Substance Abuse Texas State Profile and Underage Drinking, accessed July 2018, https://store.samhsa.gov/shin/content/PEP12-RTCUAD-
STATES/texas_profile.pdf
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In El Paso as of May 2018 there have been 21 citations for violations of the Social Host Ordinance. Of
those violations, those cited have the option of paying the fine ranging from $100-$1000, or will have
the option to take an Alcohol Education class in lieu of the fine. Prior to the ordinance, there was no
mechanism or tool for the El Paso Police Department to cite underage drinking parties. Surrounding
communities of El Paso, such as Anthony, Texas and Horizon, Texas are in the process of adopting
similar Social Host Ordinances.
Young people report drinking mostly in social settings, due to their inability to purchase alcoholic
beverages. Strategies enforcing and limiting these types of parties includes policies such as the Social
Host Ordinance.
Marijuana Access
Marijuana access and the perception of harm has changed in recent years. Research on alcohol and
tobacco has shown that the use of these substances by youths is higher in places where there is easier
access by adults. Today’s marijuana is much stronger than 20 years ago. The DEA reports higher
strains with as much as 12 times more THC compared to the potency of marijuana decades ago. The
research has also shown many youths who do smoke marijuana are likely to become dependent if used
long term, and on a daily basis up to 25% and 50%. Access to marijuana can increase the likelihood in
the use of other substances such as alcohol and prescription medication. Combination of low doses of
alcohol and marijuana could mean more marijuana involved traffic fatalities. Data below are from the
Texas Highway Patrol on the number of citations involving substances for year 2016 (most recent data
available).
TABLE 73 - TEXAS HIGHWAY PATROL CITATIONS, ALCOHOL, MARIJUANA AND OTHER DRUGS, 2016
DWI Arrests (>=21)
DUI Arrests Underage (<=21)
Poss. Of MA(<=4oz)
Poss. Dangerous
Drug Offenses
Brewster 22 2 22 --
Culberson 13 -- 15 1
El Paso 414 40 131 5
Hudspeth 60 1 17 --
Jeff Davis 8 -- 5 --
Presidio 24 2 15 --
Data Source: Data Report for PRC Region 10. Highway Safety Operations Center. Texas Highway Patrol
Citations. El Paso HIDTA 2017.
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Prescription Drugs and Opiates
National Crisis
The Center for Disease Controls estimates more than 115 people in the United States die after
overdosing on opioids22. The misuse of all classes of opioids including heroin and fentanyl (synthetic
pain relievers) has become a national crisis that demands attention at the social and economic level.
Total economic burden of prescription opioid misuse in the United States exceeds $78.5 billion per year.
The burden consists of healthcare, addiction treatment and legal costs.
Attention to the crisis began in early 2015 when the CDC reported more than 33,00 people died as a
result of an opioid overdose that included new synthetic street drugs manufactured by traffickers in
forms of fentanyl and heroin. Below are data related to the opioid crisis from the National Institute on
Drug Abuse, Advancing Addiction Science23.
Roughly 21 to 29 percent of patients prescribed opioids for chronic pain misuse them.
Between 8 and 12 percent develop an opioid use disorder.
An estimated 4 to 6 percent who misuse prescription opioids transition to heroin.
About 80 percent of people who use heroin first misused prescription opioids.
Opioid overdoses increased 30 percent from July 2016 through September 2017 in 52 areas in
45 states.
The Midwestern region saw opioid overdoses increase 70 percent from July 2016 through
September 2017.
Opioid overdoses in large cities increase by 54 percent in 16 states.
Data from the National Survey on Drug Use and Health (NSDUH), found pain relievers (i.e., opioids) are
the most commonly misused type of prescription drug, far exceeding the misuse and abuse of any
other drug, including stimulants, tranquilizers, and sedatives. The term opioid is a class of drugs derived
from opium, it is also manufactured synthetically with a chemical structure similar to opium.
Heroin is a naturally derived opioid. Other opioids, including oxycodone (OxyContin), morphine,
methadone, and codeine are used therapeutically for the management of pain and other conditions.
The substances may be diverted from pharmaceutical purposes and used illicitly, and have an extremely
high potential for abuse due to their chemical structure for dependence. Data related to opioid misuse
including queries in the Prescription Monitoring Program aid in the development of programming
addressing the crisis at the level of intervention, prevention, treatment and recovery.
22 CDC/NCHS, National Vital Statistics System, Mortality. CDC Wonder, Atlanta, GA: US Department of Health and Human Services, CDC; 2017.
Accessed July 2018, https://wonder.cdc.gov. 23 National Institute on Drug Abuse, Advancing Addiction Science, Opioid Overdose Crisis Summary Report, revised March 2018,
https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis, accessed July 2018.
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TABLE 74 - PRESCRIPTION MONITORING PROGRAM QUERIES, 2016-2017
STATE QUERIES 2017 QUERIES 2016 2016-17 PERCENT CHANGE
ARIZONA 9,959,844 3,975,220 150.5
CALIFORNIA 9,977,133 9,581,280 4.1
NEW MEXICO 1,304,013 938,940 38.9
OKLAHOMA 5,035,904 5,478,498 -8.1
TEXAS 4,163,058 1,086,373 283.2
DOCTORS ARE INCREASINGLY USING PRESCRIPTION DRUG MONITORING PROGRAMS, IN AN EFFORT TO CUT DOWN ON INAPPROPRIATE PRESCRIPTIONS 24
24 American Medical Association, Article: Doctors getting more careful about opioids, Change in prescription drug monitoring queries, 2016-17.
Data Source: American Medical Association, Get the Data, Cartogram: AndrewWitherspoon/Axios, accessed July
2018, https://www.axios.com/doctors-are-being-more-careful-about-opioids
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TABLE 75 - MOST COMMONLY DIVERTED MEDICATIONS, 2017
County Prescription Drug Plans Medicare Advantage
Prescription Drug Total
Count Percent
Count Percent
Count
Brewster 1,092 80%
272 20%
1,364
Culberson 317 86%
53 14%
370
El Paso 27,377 30%
63,829 70%
91,206
Hudspeth 235 51%
229 49%
464
Jeff Davis 355 86%
58 14%
413
Presidio 938 76%
298 24%
1,236
Narcotic Pain Medications
(Opioids)
Stimulant Medications
Barbiturate Sedatives
Benzodiazepine Tranquilizers
Codeine Fentanyl Meperidine - (Demerol) Methadone Hydromorphone Morphine Opium Oxycodone Hydrocodone
Adderall Dextroamphetamine (Dexedrine) Focalin Methylphenidate - (Ritalin)
Amobarbital Pentobarbital Secobarbital Phenobarbitol
Clonazepam Diazepam Estazolam Flunitrazepam (Rohypnol) Lorazepam Midazolam Nitrazepam Oxazepam Triazolam Temazepam Chlordiazepoxide (Librium)
TABLE 76 - REGION 10, Medicare Prescription Drug Enrollment, 2017
Data Source: Prevention Resource Center - Region 10. Prescription Medication Flyer 2017.
Data Source: Medicare Enrollment Dashboard Prescription Drug Plans. https://www.cms.gov/Research-Statistics-
Data-and-Systems/Statistics-Trends-and-Reports/CMSProgramStatistics/Dashboard.html. Accessed July 2018.
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Dispensations by DEA Schedule Year
County 2015 2016 Grand Total
BREWSTER 12,444 13,921 26365
2 3111 3484 6595
3 1337 1563 2900
4 6249 6830 13079
5 18 23 41
99 1729 2021 3750
EL PASO 751124 754321 1505445
2 173529 173731 347260
3 102521 106427 208948
4 353023 356136 709159
5 3495 3001 6496
6 1
1
99 118555 115026 233581
PRESIDIO
28 28
2
15 15
3
4 4
4
6 6
99
3 3
Grand Total 763568 768270 1531838 *Region 10 counties not listed did not have data available.
**99 denotes data was unspecified Data source: Texas State Board of Pharmacy Prescriptions Monitoring Program by
Texas licensed pharmacies 2015-2016. Accessed May 2018.
TABLE 77 - REGION 10, Dispensations by DEA Schedule, 2015-2016
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Illegal Drugs on School Property
Disciplinary Action Reasons codes and Definitions/2016-2017 PEIMS/Texas Education Standards
Data source: Texas Education Agency Region Level School Standards. https://rptsvr1.tea.texas.gov/cgi/sas/broker. Accessed July 2018.
Marijuana or Controlled Substance or Dangerous Drug - TEC §37.006(a)(2)(C) and
§37.007(b)(2)(A) sells, gives, or delivers to another person or possesses or uses or is under the
influence of marijuana or a controlled substance, as defined by Health and Safety Code
Chapter 481, or a dangerous drug, as defined by Health and Safety Code Chapter 483.
Health and Safety Code Chapter 481 defines marijuana as Cannabis Sativa whether growing or
not, the seeds of the plant, and every compound, manufacture, salt, derivative, mixture, or
preparation of that plant or its seeds. The term does not include resin extracted from a part of
the plant, the mature stalks of the plant or fiber produced from the stalks, oil or cake made
from the seeds of the plant, the sterilized seeds of the plant or a compound, manufacture, salt,
derivative, mixture, or preparations of the mature stalks, fiber, oil or cake.
Health and Safety Code Chapter 481 defines a controlled substance as a substance, including a
drug and an immediate precursor, listed in Schedules I-V or penalty Groups 1-4 of the Health
and Safety Code. Possession of any amount in Penalty Groups 1 and 2 is a felony. Possession
of a controlled substance in Penalty Groups 3 and 4 is a felony if the amount is more than 28
grams. It is also a felony to deliver a controlled substance to a minor. (However, this offense
does not apply to minors in some circumstances.)
Health and Safety Code Chapter 483 defines a dangerous drug as a device or a drug that is
unsafe for self-medication and that is not included in Schedules I-V or penalty Groups 1-4 of
the Health and Safety Code. The term includes a device or drug that bears or is required to
bear the legend:
(a) Caution: federal law prohibits dispensing without a prescription; or
(b) Caution: federal law restricts this drug to use by or on the order of a licensed
veterinarian.
"Marijuana or Controlled Substance or Dangerous Drug" violation is also a discretionary
expellable offense dependent on the local Student Code of Conduct.
If a violation under this category is committed at a felony level, then the student must be
expelled from their regular education setting.
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Enrollment 2017 Region Discipline
Population
Controlled
Substances/Drugs
Alcohol Violations
Edu Svc
Center 18
93,682 10,602 673 46
Edu Svc
Center 19
186,414 13,477 854 93
Region 10
Totals
280,096 24,079 1,527 139
Current Use
Like many states across the nation, Texas is facing unsurmountable odds when it comes to persons
becoming addicted to prescription opioids. Opioid medication is typically prescribed by a physician for
pain from injuries, surgeries and other painful conditions. While most medication is for legitimate
medical purposes, many are being manufactured illicitly and sold on the street for profit. According to
Dr. Jane Maxwell, from the School of Social Work in Austin, Texas, “hydrocodone is the most prevalent
opioid used for non-medicinal purposes in the state.” Region 10 is experiencing higher rates of Cocaine
and Methamphetamine use along with increased law enforcement drug seizures of Marijuana. The
large numbers of addicted persons have little to no knowledge of the true addictive nature of the
synthetic drugs sold to them.
State of Texas drug overdose data, 2015-2016:
2015 - 590 deaths
2016 - 617 deaths
*Drug overdose deaths are defined as natural and semi-synthetic opioids and methadone contributing
causes.
TABLE 78 - EDUCATION SERVICE CENTER 18 AND 19 (REGION 10), DISCIPLINE DATA, 2017
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El Paso County Number of
Drug Related Deaths
6172
8268
91103
0
20
40
60
80
100
120
2012 2013 2014 2015 2016 2017
2017
2016
2015
2014
2013
2012
Kfox news story, Medical Examiners Office, 2017
Disease (Morbidity) Related to Substance Abuse
Drug overdose was the leading cause of injury death in 2016 according to County Health Rankings &
Roadmaps. Among people 25 to 64 years old, drug overdose caused more deaths than motor vehicle
traffic crashes25. The El Paso County Office of the Medical Examiner’s Office reported (83) deaths
related to Acute Drug Toxicity, (10) deaths from Mixed Alcohol and Drug Toxicity and (1) death Acute
Alcohol Toxicity. El Paso County had 615 drug poisoning deaths as of 2016, which is up from 542 in
2015.
Table 79 - Single Drug-Related Deaths - Drug Involved, 2016
El Paso
County
# of cases
Heroin 16
Cocaine 8
Fentanyl 4
Morphine 2
Ethanol 2
Tramadol 2
Data Source: El Paso County Office of the Medical Examiner, 2016 Annual Report, accessed July 2018,
file:///C:/Users/David/Documents/2018%20RNA%20data/2016%20EPOME%20Annual%20Report.pdf
25 County Health Rankings, Drug Poisoning Deaths, accessed July 2018,
https://assessment.communitycommons.org/CHNA/report?page=6&reporttype=libraryCHNA
Figure 11. El Paso County Number of Drug Related Deaths, 2012-2017
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Table 80 - Multiple Drug-Related Deaths - Most Frequently Involved Drugs
*only drugs involved in >4 cases are mentioned *Heroin was present in 34% of all multiple drug-related deaths
Data Source: El Paso County Office of the Medical Examiner, 2016 Annual Report, accessed July 2018,
file:///C:/Users/David/Documents/2018%20RNA%20data/2016%20EPOME%20Annual%20Report.pdf
El Paso County # of cases
Heroin 16
Cocaine 11
Alprazolam 10
Ethanol 10
Morphine 11
Hydrocodone 9
Clonazepam 7
Morphine 7
Diazepam 5
Methadone 5
Oxycodone 5
Fentanyl 4
Codeine 4
Cyclobenzaprine 4
Oxymorphone 4
Tramadol 4
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National Magnitude of the Problem (last updated September, 2017)
More than 64,070 drug overdose deaths in 2016
Sharpest increase related to fentanyl related deaths with over 20,000
Deaths involving Opioids and Cocaine have more than doubled
Overdose death due to Heroin, 2015: 9,881 Males, 3,108 Females
Overdose death due to Illicit Opioids, 2015: 14,426 Males, 5,458 Females
Opioid Crisis: National Related Trends
Lack of Education about Opioid Use Disorders
Increased Availability of Heroin
Widespread Prescribing of Opioids
Increased Hopelessness and Depression associated with Economic Decline
Figure 12. Benzodiazepines and Opioids related deaths, 2002-2015
Data Source: National Institute on Drug Abuse, National Overdose Deaths, 2002-2015.
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Figure 13. Cocaine and Opioids related deaths
Data Source: National Institute on Drug Abuse, National Overdose Deaths, 2002-2015.
Risk Factors for Drug Use in the Region
Domestic violence
Fear of Deportation
Perception of harm for Marijuana use
Acculturation
Social Isolation
Poorest areas in the nation
High teen age pregnancy rates
Low education attainment
Linguistic barriers
Lack of healthcare insurance
Fentanyl and Opiate Dangers
Beginning in 2016, the Drug Enforcement Administration issued a nationwide alert identifying fentanyl
as a threat to public health and safety. Fentanyl is a synthetic opioid that is 50-100 times more potent
than morphine. States across the country are experiencing increases of fentanyl involved overdose
deaths. The DEA also reported over a 323% increase of deaths from synthetic opioid deaths during
years 2014-2016.
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Special Topics: Opioids Region 10 Current Use
The Drug Enforcement Administration El Paso Division has cultivated several collaborations and partnerships with the implementation of their Community Outreach Personnel. The collaboration allows for the reporting of seizure data, along with sharing similar prevention and intervention efforts. The number of people dying from an opioid overdose has increased every year in the State of Texas. So while rates remain low, the cause for concern remains as the data shows steady increases in several Texas Counties.
Region 10 has partnerships with many of the law enforcement agencies that are reporting increased arrests and seizures that include illegal and illicit drug use. For Region 10 there has been an increase of marijuana, methamphetamine and cocaine specifically for this area and their increased use. Treatment centers for this area have also reported a surge of clients whose source of addiction stems from methamphetamine and cocaine use.
Deaths related to opioid use are hard to identify with just hospital data. Many of the trends are identified through the compilation of treatment center data, law enforcement agencies and the hospitals. Due to the nature of an individual presenting at the hospital with a health consequence from taking a prescription opioid, it may or may not be reported in the electronic intake system. If an individual dies from an overdose from an opioid, it may not be known unless an autopsy is performed or the information is voluntarily placed in the person’s medical record. As of 2017 there were 103 reported deaths for El Paso from opioids. The known trends in the area are discussed in the following sections.
Emerging Trends
Drug trends help us understand prevalence of drug use and the consumption patterns of drugs over
time. Unfortunately, as often as we monitor these drug trends, new drugs emerge changing the norm
among usage. The street drug form of Fentanyl has been found in many of the illicit drugs on the
market. With its potency 100 times more than heroin, it has been found in many of the heroin, spice
and designer drug pills currently seized by law enforcement. Current trends for the area also include
street drugs known as ‘Spice’, or the new tobacco novelty ‘Juul’s have grown in popularity. These drugs
are dangerous and a brief description is provided here to help build awareness on the most current
trends.
Fentanyl
Fentanyl is a synthetic opioid analgesic created to mimic the pain relieving opiate receptor. It has historically been used as a pain reliever in both human and veterinary medicine. Fentanyl was first synthesized by Paul Janssen in 1960 and marketed as a medicinal product for treating pain. There are several derivatives of the drug including sufentanil, alfentanil, remifentanil, and carfentanil. Fentanyl was first introduced as a pain patch for pain management purposes. The current illicit drug form has increased the amount of opioid related deaths26.
26 Drug War Facts, What is Fentanyl?, accessed July 2018, http://drugwarfacts.org/chapter/fentanyl
Photo Credit: Shutterstock
Photo Credit: Shutterstock
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Juul
Juul is a new vapor product on the market targeted at
young adults. They are sold in convenience stores along
with tobacco products. A single juul pod contains
50mg/ml of nicotine, which equals to the same amount
as a pack of cigarettes. Juul vapor is thin and dissipates
fast, making it easy to smoke in classrooms or restrooms
without the fear of being caught. The Juul product is quickly becoming
popular not only with adults, but with teenagers as well due to the choice
of colors, flavors and affordability. The resemblance to a hard drive also
makes it attractive to young adolescents. 65% of Juul users age 15-25 didn’t know that Juuls always
contain nicotine.
Synthetic Cannabinoids (SPICE)
Spice is a synthetic drug created in a laboratory that eventually made its
way to the streets in Europe before making its way to the United States. In
the 1990’s, J.W. Huffman at Clemson University created a large series of
compounds27. These compounds were primarily developed as
pharmaceutical agents intended for pain management also known as
analgesic drugs.
Spice is a mixture of herbs that are dried in a similar fashion to marijuana
and combined with the manmade compounds explained above. Most products have added chemicals
that the designers of the drug include at their discretion. Spice is known to be sold at local convenience
stores and tobacco shops, as well as the availability of buying it online. The mixture of unknown
chemicals in Spice has prompted many more calls to poison control centers nationally including region
10. It should be noted that Spice is illegal, yet producers of the drug continuously change the formula
of the product to evade legal restrictions. The TSS 2016 for Region 10 report that the average age of
initiation for grades 6-12 is 14 years old.
Past Month School Year Ever Used Never Used
All 1.8% 2.7% 5.9% 94.1%
Grade 7 1.1% 1.6% 3.0% 97.0%
Grade 8 2.6% 3.2% 4.7% 95.3%
Grade 9 2.1% 3.0% 6.5% 93.5%
Grade 10 2.2% 3.2% 6.2% 93.8%
Grade 11 1.4% 2.6% 7.6% 92.4%
Grade 12 1.4% 2.5% 7.4% 92.6%
27 European Monitoring Centre for Drugs and Drug Addiction, Understanding the ‘Spice’ phenomenon
Table 81 - Synthetic Marijuana Consumption, grades 6-12, TSS
2016
Photo Credit: Shutterstock
Photo Credit: Shutterstock
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Photo credit: Partners for Drug-Free Kids
Region Age of Initiation Early Initiation (<13)
State 14.2 14.7%
Region 10 14.0 16.5% Data Source: Texas State School Survey of Drug and Alcohol Use, Region 10, the Public Policy Research Institute Texas A&M University, 2018.
Synthetic Cathinones
Much like Spice, Bath Salts have emerged rapidly among
Europe and the United States. Bath Salts contain a
number of chemicals that can produce euphoria and
increased sociability and sex drive.
Common synthetic cathinones found in bath salts include
3, 4-methylenedioxypyrovalerone (MDPV), mephedrone
(“Drone,” “Meph,” or “Meow Meow”), and methylone, but
there are many others28.
Bath salts users have reported intense cravings (or a
compulsive urge to use the drug again) and that they are
highly addictive according to NIDA.
Synthetic Cathinones should not be confused with products marked “bath salt” or Epsom salts that are
used for bathing. These types of products have no mind- altering ingredients.
E-Cigarettes/Vaping
The Surgeon General released an Executive Summary
report in 2016. Findings in the report warned of the
alarming rate of e-cigarette among youth. The report also
stated e-cigarette use as the most common used tobacco
product among youth in the United States29. The Center
for Disease Control and Prevention reported that e-
cigarette use has tripled among middle and high school
students in less than a year in a press release on April 16,
2015.
The CDC also reported e-cigarette use (use on at least 1 day in the past 30 days) among high school
students increased from 6.5 percent in 2015 to 15.4 percent in 2016, rising from approximately 660,000
to 2 million students30.
28 National Institute on Drug Abuse, Drug Facts: Synthetic Cathinones (“Bath Salts”), 2018. 29 U.S. Department of Health and Human Services. E-Cigarette Use Among Youth and Young Adults: A Report of the Surgeon General—Executive Summary. Atlanta, GA: U.S. Department of Health, 2017. and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2016. 30 Centers for Disease Control and Prevention, E-cigarette use triples among middle and high school students in just one year, 2016.
Table 82 - Synthetic Marijuana Initiation, grades 6-12, TSS
2016
Photo credit: Partners for Drug-Free Kids
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In a separate press release, the CDC announced that more than half (53.1 percent) of the calls to poison
centers due to e-cigarettes involved young children under age 5, and about 47 percent of the poison
calls involved people age 20 and older31.
BHO “Dabbing “and Consumables
Butane Hash Oil (BHO) is an extract high in THC
levels and is extremely dangerous to create. The
process includes filtering marijuana with butane and
then boiling the butane from the marijuana. This
has caused many fires and explosions in homes
where individuals are attempting to create this
substance. If successful, users are left with a product
that can be used to dab there e-cigarette or vaping
machines to get an odorless high off of the BHO.
Other forms can be created after the substance is
extracted to place in food as an oil, create a wax or
butter to place in lip balms, or shatter that look
similar to peanut brittle.
31 Centers for Disease Control and Prevention, New CDC study finds dramatic increase in e-cigarette-related calls to poison centers, 2016.
Photo credit: Partners for Drug-Free Kids
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Consequences
Overview of Consequences
The use of drugs and alcohol result in a number of individuals that find themselves in hospitalization or
in other cases they die as a result of their substance use. Not only do individuals who abuse drugs and
alcohol place themselves at risk, but those around them are also impacted by their usage of substances.
Mortality
Measuring morbidity and mortality rates allows assessing linkages between social determinants of
health and outcomes. By comparing, for example, the prevalence of certain chronic diseases to
indicators in other categories (e.g., poor diet and exercise) with outcomes (e.g., high rates of obesity
and diabetes), various causal relationship may emerge, allowing a better understanding of how certain
community health needs may be addressed. Below are data related to national substance use rates:
Date Source: National Institute on Drug Abuse, Overdose Death Rates 2000-2016, accessed July 2018,
https://d14rmgtrwzf5a.cloudfront.net/sites/default/files/overdosedeaths1.jpg
Figure 14. Drugs Involved in U.S. Overdose Deaths, 2000 -2016
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Date Source: CDC Vital Signs, January 2015, www.cdc.gov/vitalsigns. National Center for Health Statistics Mortality Multiple Causes, 2010-
2012
Legal Consequences Drug and/or Alcohol Related Inmate Population Over 100,000 people die every year due to drinking and
driving incidences. Drug driving has also become an
issue with many people under the influence of
prescription medication. With a conviction of either of
those two offenses, many will face jail time, loss of
employment, loss of custody of their children, court-
ordered treatment, financial aid for college, and
professional licensing to name a few. In Texas the data collected for incarceration by the Bureau of
Justice Statistics, National Prisoner Statistics Program, reported the following number of incarcerated
prisoners for years 2014-2016*:
2014: 166,043
2015: 163,909
2016: 163,703
*data include total jail and prison populations32.
32 Bureau of Justice Statistics, Total Jurisdictional Count 2014-2016, Generated using the Corrections Statistical Analysis tool at www.bjs.gov.
Photo credit: Serenity Summit Treatment Center
Figure 15. Poisoning Deaths among adults, 2010-2012
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Below is a table displaying the population by counties in our region as of 2015 (most recent data
available). State of Texas totals for DWI (liquor and drugs offenses) 1,098 as of May 2018.
County Drug/Alcohol Inmates
Brewster 20 Culberson 5
El Paso 2,117 Hudspeth 8 Jeff Davis 3 Presidio 11
Total 2,164
Table 83 - Inmate Population, Drug/Alcohol offenses, 2015
Data Source: Texas Department of Criminal Justice Records, 2015
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Photo Source: SAMHSA
Environmental Protective Factors There are a multitude of
opportunities for addressing
behavior health problems and
disorders. By increasing the
amount of evidence-based
practices in our community, the
likelihood we increase protective
factors. Prevention is at the core of
providing a continuum of care, and
part of a comprehensive approach
to behavioral health.
Prevention strategies are focused
on helping develop knowledge,
attitudes, and skills to help individuals
make good choices and/or change harmful behaviors33. Prevention is an attempt to reach individuals
before the onset of a disorder and is intended to prevent or reduce the risk of developing a behavioral
health problem.
Region 10 is striving to provide services to individuals across the continuum of care and create
opportunities of individuals to succeed.
Overview of Protective Factors
Community Domain PRC 10 currently collaborates with many HHSC-funded and non-funded Community Coalitions,
agencies, individuals and organizations working in prevention services focused on the three state
priorities of underage drinking, synthetic marijuana and prescription medication. The mobilization
efforts address the needs of populations identified by each of the related sectors. Their goal is to
implement evidenced-based practices utilizing the Strategic Prevention Framework in promoting the
activities related to substance use issues and healthy living in their communities.
Many of the partnerships are mentioned bellowed and future collaborations can only be beneficial in
promoting awareness to the substance use issues affecting the counties of Region 10.
Community Coalitions
The Texas Department of Health and Human Services has funded a number of programs to provide
service throughout Region 10. These programs not only focus on the individual, they also create
33 SAMHSA, Prevention of Substance Abuse and Mental Illness, Prevention Strategies.
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environmental change that supports healthy behaviors. These services are provided through Universal,
Selective, and Indicated programming34:
Universal (YPU) - Prevention programs that are designed to reach the entire population,
without regard to individual risk factors and are intended to reach a very large audience.
Selective (YPS) - Prevention programs that target subgroups of the general population that
are determined to be at risk for substance abuse.
Indicated (YPI) - Prevention intervention programs that identify individuals who are
experiencing early signs of substance abuse and other related problem behaviors
associated with substance abuse and target them with special programs.
Additional to the services above, HHSC funds Community Coalition Programs (CCP) throughout the
state. The coalitions address community concerns regarding the prevention and reduction of the illegal
and harmful use of alcohol, tobacco, and other drugs in target counties35.
Youth Prevention Programs PRIDES (YPU) - Aliviane, Inc.
PRIDES is an acronym for Prevention and Intervention of Drug Abuse through the Enhancement of Self
Esteem. The PRIDES program provides
universal prevention services that promote a
process of addressing health and wellness for
individuals, families, and communities in the
El Paso County and Culberson County that
increase knowledge, skills, and attitudes
necessary for making positive life choices.
PRIDES services include outreach to the
community, linkages to behavioral health
services throughout Far West Texas, and the
use of Life Skills Training for families to
increase pro-social behaviors among that
promote healthy and drug-free lifestyles.
34 Texas Department of State Health Services, Universal, Selective, and Indicated Prevention. 35 Texas Department of State Health Services, Substance Abuse Prevention Services: Community Coalition Programs (CCP).
Photo credit: Shutterstock
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Photo credit: Aliviane, Inc.
Strengthening Families (YPS) - Aliviane, Inc.
With a special focus on youth ages 12 to 16,
Strengthening Families is a family based
prevention program that promotes healthy living,
awareness of risks
related to alcohol,
tobacco and other
drugs, and community
involvement through
activities that are
educational, fun, and
inspiring for everyone in
the family.
Strengthening Families addresses risks related to
substance abuse and other risks factors associated
with school failure, delinquency, social problems
and violence at home, school, or in the community, poverty, gang involvement and other issues.
IMASTAR (YPI) - Aliviane, Inc.
IMASTAR stands for: I’m Motivated to learn, I’m
Achieving my goals, I’m Staying drug and
alcohol free, I’m Thinking about my future, I’m
Active in my School, I’m Responsible for my
success. IMASTAR is a prevention program that
has been serving youth in El Paso County since
1994. The program addresses involvement in
substance abuse and other high risk behavior
such as poor grades, excessive unexcused
absenteeism, tardiness, disruptive behavior,
gang activity, repeated suspensions, social
problems, and family dysfunction.
Youth in IMASTAR are provided with comprehensive screening and service planning, prevention
education skills training, prevention counseling, referral support, AOD Presentations and Tobacco
presentations. Participants are also engaged in fun activities that are culturally relevant, offset
attraction to the use of alcohol, tobacco or other drugs and foster bonding with peers, family, school
and community.
Photo credit: Strengthening Families Program Curriculum
website
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El Paso Advocates for Prevention Coalition
(CCP) - Aliviane, Inc.
El Paso Advocates for Prevention Coalition,
also known as the El Paso APC is a community
coalition partnership serving the communities
rural areas of El Paso County.
The El Paso APC works towards prevention
and reduction of the illegal and harmful use of
alcohol, tobacco, and other drugs in El Paso
County, amongst youth and adults, by
promoting and conducting community-based
and evidence-based prevention strategies with
key stakeholders.
This year the coalition was able to install their first prescription drop box to serve the residents of El
Paso County. The collaboration is a unique one as the coalition and its members were able to partner
with a county hospital for the implementation of the drop box, and the disposal of prescription
medication.
Photos courtesy of: Aliviane, Inc., 2018
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Alcohol and Substance Abuse Program (ASAP) -
Ysleta Del Sur Pueblo36
ASAP utilizes the Positive Action (PA) curriculum
developed by the Center for Substance Abuse
Prevention (CSAP).
PA is an evidence-based program focused on
character development and academic
improvement, which has shown strong evidence of
positive effect in prevention and intervention
strategies for Native American youth, ages 6-12.
When used in an intervention setting, such as
counseling, it promotes an intrinsic interest in
becoming a better person by encouraging a positive self-concept, educational advancement and
responsible citizenship.
CHOICES Program - Communities in Schools (CIS), El Paso37
Choices is a drug and alcohol prevention program. The goal of the “Choices” program is the prevention
of violence, alcohol, tobacco and other drug use among the youth of El Paso, specifically the CIS
targeted areas. CIS provides the Choices program weekly in 8 schools in the Ysleta and Socorro
Independent School Districts. CIS Choices provides services for other CIS campuses on a monthly basis
through presentation, information dissemination, alternative drug free activities, and career/health
fairs.
36 Ysleta del Sur Pueblo, Alcohol and Substance Abuse Program. 37 Communities In Schools, Programs, Choices.
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Rio Grande Safe Communities Coalition - University Medical Center El Paso (UMC)38
The Rio Grande Safe Communities Coalition (RGSCC) is funded through a
Community Coalition Prevention (CCP) through the Texas Department of State
Health Services, and is managed and coordinated by UMC’s Level I Trauma
Center in order to link local agencies and organizations with local community
needs.
RGSCC organizes a local coalition composed of community members
representing a minimum of 12 sectors (youth, parents, businesses, media,
schools, youth serving organizations, law enforcement agencies, religious or fraternal organizations,
civic and volunteer groups, healthcare professionals, state, local or government agencies with expertise
in the field of substance abuse, and other organizations involved in reducing substance abuse).
School Domain Students Receiving AOD Education in School
“According to the National Institute on Drug Abuse, 27.2% of students in grades 8–12 have tried drugs
in the past year. This fosters a dangerous environment not only for the kids who experiment with drug
use, but for their classmates around them. It can also create an extremely unhealthy situation for those
who are struggling to break free from addiction as well39.
A report from the Substance Abuse and Mental Health Services Administration (SAMHSA) in 2013,
estimated 2.3 million kids ages 12 to 17 had used drugs. Of those who were using drugs, only 5.4% were
entered into any kind of treatment. And the majority of them will not receive intensive outpatient
therapy.
According to recent research the better alternative would be in the development of recovery high
schools. The high schools often provide a safe space where students are not exposed to other drug-
using peers. The curriculums of the proposed school include curriculums intertwined with treatment
and support.
“Early studies show that within six months of completing a recovery school curriculum, students have a
relapse rate of only 30% – less than half of normal intervention programs.”
There are currently 34 recovery schools throughout the United States. Eight of them are in East Texas.
There are currently no treatment or recovery schools serving Region 10.
The 2016 Texas School Survey showed that students between the grades 6 and 12, mostly received
information on drugs and alcohol from assembly programs 24,065 students (54.7%) compared to
(44.7%) from 2014 survey results and the least from Science or Social Studies Class (31.3%) compared to
2014 results (27.3%). Overall, 69% of the time students received information relating to drugs or alcohol
from school.
38 Rio Grande Safe Communities, Who We Are, 2017 39 National Institute on Drug Abuse, Youth Substance Use, accessed July 2018, https://www.drugabuse.gov/drugs-abuse/opioids
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Trends of Substance Use in the Region
Region 10 is experience an increase of tobacco use, as well as the increase use of vaping products
among youth compared to last year. Decrease in prescription medication among youth is identified
through the survey results of the Texas School Survey. Further trends include the increase of
Methamphetamines by adults, and prescription medication among the senior population. The
information is derived from treatment organizations and coalitions collecting data via surveys and
stakeholder discussions.
Region in Focus Due to its size and location, Region 10 is secluded from the rest of Texas. The need for services in the
large and rural counties is clear when reviewing the data in the regional needs assessment. The region
has found ways to be innovative in their approach to substance use treatment services out of the
necessity to provide adequate services. The regional data that was collected and provided in this
regional needs assessment is a glimpse into the region’s challenges in the prevention of substance
abuse. Further data on Region 10 is available from each section, and further data related to other topics
outside of the realm of substance abuse is available through the PRC10 upon request.
http://recoveryschools.capacitype.com/map
Figure 16. Map of current Recovery Schools in the U.S., 2018
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Our hope is that organizations, community stakeholders, foundations, or anyone interested in
providing services to our region will find this RNA useful in their efforts.
Gaps in Services The greatest barrier to receiving services is our lack of transportation throughout the region. El Paso
County provides a large amount of services that are available to the region, yet travel from areas such
as Presidio or Marfa takes hours. Furthermore, our colonias in Region 10 suffer from extremely poor
road conditions where in some cases the roadways are unpaved and flood during even small amounts of
rain.
Areas in the region such as Presidio County have expressed to the PRC10 that services for substance
abuse prevention are needed. In stakeholders meetings with the rural communities of Region 10
including Presidio County, and Jeff Davis County, the members expressed the need for treatment
services for substance abuse due to the fact that the nearest facility is located in El Paso County which
is 250 miles away. This is the case for most of Region 10 when seeking out services for family members
for substance abuse and mental health services in the rural counties.
Gaps in Data While this assessment is considered comprehensive, the reporting and selection of the measures
cannot represent all aspects of health in the community, nor do we represent all populations of interest.
As a community we must recognize the data gaps might in some ways limit the ability to assess a
community’s health needs.
For example, we recognize certain populations groups were not recognized in the assessment by any
survey data, these include but not limited to the homeless, institutionalized persons, or those who
speak another language other than English or Spanish. It is often difficult to identify other populations
by independent analysis such as pregnant women, the LGBT community, and undocumented residents.
In terms of content, the Regional Needs Assessment was designed to provide a broad and
comprehensive picture of the health of the overall counties under Region 10. However, there are
certainly a great number of behavioral health conditions that were not specifically addressed. With the
current assessment, we can outline gaps in data identified by the PRC10 in the following areas:
Texas School Survey data from our large school districts such as El Paso Independent School
District, Socorro Independent School District, and others (same as previous years)
County level data on the synthetic drug use, abuse, and overdose (same as last year)
County level data on the economic impact substance abuse and use has on the community
(same as last year)
County level data on emergency room visits due to substance abuse or use (ongoing from
previous years)
County level data on the tribal communities located in Region10 (same as previous years)
Number of youth and adolescents in need of treatment services (new this year)
Number of youth and adults suffering from an opiate addiction (new this year)
Number of Naloxone saves from overdose deaths (new this year)
Ambulatory data related to substance use (new this year)
Update crime statistics from most current years (ongoing from previous years)
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This list could go further, and the Prevention Resource Centers across the state are working together in
efforts toward collecting this data. Our targets for data collection are in the areas of drug abuse
treatment and prevention/intervention programs, local hospitals, county and local health departments,
medical examiner’s office, poison control centers, drug helplines, mental health centers, HIV/STD
outreach programs, pharmaceutical associations, county forensic labs, criminal justice/police reports,
drug seizures - drug cost/purity, education/school districts, recreation centers, and university
researchers.
Regional Partners The Prevention Resource Center in Region 10 has found the collaboration of prevention providers a
huge success as outlined in the data collected for the RNA, as well as for activities and outcomes for
fiscal year 2017-2018. Below are some of the successes experienced by the PRC-Region 10 along with
its regional partners.
Regional Successes The Rise Up Region 10 Task Force was convened in March, 2017 to effectively tackle the issue of
prescription medication misuse. The Task Force is spearheaded by the Region 10 Prevention Resource
Center in El Paso, Texas. Any trends of substance use are effectively monitored by its members. To
draw attention to the unique community needs, the PRC reached out to its prevention provider
partners and their Epidemiological workgroup to establish what is now named the Region 10 Rise Up
Task Force. Region 10 covers the 6 counties of Brewster, Culberson, El Paso, Hudspeth, Jeff Davis, and
Presidio. The Task Force and its members for this fiscal year participated in conferences, media events,
billboard campaigns and advocacy issues focused on underage drinking. The Task Force has plans to
continue their work and focus on the drug trends facing the communities in Region 10.
The Task Force is currently working on strategies that will be applied to campaigns of Marijuana/Spice
and prescription medication to lower the rates of addiction among individuals in Region 10. In doing so,
billboards, and other media activities will be marketed to the communities in the 6 counties.
The Task Force has taken the recommendations from the community, state wide recommendations,
and national evidenced-based strategies of the Prescription Monitoring Program, establishing 24/7
prescription drop boxes, education and training in schools, and marketing of prevention messages.
Each member of the Task Force is passionate about the issue of substance misuse in their community.
Many of the professionals have been working in the field for many years and have never seen such an
epidemic, and have committed their time and efforts now and in the future to solve the problem.
The collaboration of partners has helped to develop relevant prevention messages, plan a Behavioral
Health Conference which had over 300 participants locally and regionally, a media campaign that
continues to be associated with the Task Force logo, a Town Hall Meeting discussing Prescription
Misuse in our Community, Partnership with the EPPD to place Deterra Medication Disposal Bags with
Command Centers in El Paso, Texas, and continuing prevention education to as many school districts
on all related drug trends.
Region 10 is fortunate to have such dedicated professionals and leaders to continue working on the
prescription drug misuse issue for the healthy success of our communities.
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The agencies represented in the Task Force include:
El Paso Independent School District
El Paso Police Department
Rio Grande Safe Communities
Smoke Free Paso del Norte
University of Texas at El Paso
West Texas Poison Control
Drug Enforcement Administration
Trinity Homeward Bound Treatment Services
Community in Schools
Emergence Health Network
Advocates for Prevention
Paso del Norte Health Foundation
El Paso Behavioral Health
West Texas High Intensity Drug Trafficking Agency
Community Youth Development Coalition
Alliance of Border Collaboratives
Alcohol Impact Network
The PRC10 will continue to expand its outreach and partnerships in the areas of substance use and
behavioral health. Addressing the diverse public health needs of county citizens, the success of past
collaborations and dynamic plans for 2018-2019 would not be possible without our partners throughout
our 6 counties of Brewster, Culberson, Hudspeth, El Paso, Jeff Davis and Presidio. The PRC10 looks
forward to the privilege of serving the community through people, prevention and partnerships.
Conclusion The Regional Needs Assessment report yielded a wealth of information about the health status,
behaviors and needs for our population. A distinct advantage of the RNA is the ability to have a broad
focus on the primary and chronic disease needs and other health issues of vulnerable populations, such
as uninsured persons and racial/ethnic minority groups.
Based on the findings of the RNA it is important for the community to address issues related to alcohol,
marijuana, and prescription drug abuse. Collective impact has been used throughout the world and has
been shown to have the greatest changes in the communities. Instead of an organization competing
against others to obtain the greatest change, though collective impact, organizations work together
toward the same goal40.
It is important to understand that although one risk factor is being addressed not much change may be
seen unless all of the risk factors are addressed at the same time41. For collective impact to work, it is
40 Hanley Brown, Fay, John Kania, and Mark Kramer. "Channeling change: Making collective impact work." Stanford Social Innovation Review 20 (2012): 1-8. 41 Kania, John, and Mark Kramer. "Collective impact." (2011): 36-41.
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important to identify key players that can converge and organize their goals to align with each other in
order to sustain action and impact.
In order to achieve this, the Prevention Resource Center will serve as the backbone organization
providing strategic direction, facilitating dialogue between key players, managing data collection and
analysis, coordinating community outreach, and mobilizing strategies for funding.
Key Findings The following “health priorities” represent recommended areas of intervention based on the
information gathered through the process of collecting data for the RNA and guidelines from the Texas
Department of Health and Human Services and the Healthy People 2020 mandate.
Alcohol continues to be the prevailing substance used and abused which is widespread in Region 10.
The Texas School Survey continues to identify our youth as continuing to gain access to alcohol and the
prevalence of use increasing. Treatment services for youth in El Paso County continues to be primarily
for the abuse of marijuana.
At Aliviane, Inc.’s Treatment Resources for adults, the top 3 drugs of choice for 2017-2018 were Heroin
(35%), Amphetamines (23%), Alcohol (22%), and Cocaine (15%), compared to last year’s percentages of
Alcohol (36%), Cocaine (20%), Amphetamines (20%) and Heroin (20%). Currently, as of June 2018,
Aliviane, Inc., is treating 650 patients, (496) Outpatient clients and (154) Inpatient clients. Adolescents
in treatment for mainly marijuana misuse were 144 as of June 2018.
The increased inpatient clientel of Heroin addiction provides further indication of the Opioid misuse
issue for the region. Among adults in El Paso County receiving substance abuse treatment, alcohol and
cocaine are still high ranking primary drugs of choice throughout residential and outpatient services
among individuals.
Summary of Region Compared to State
A report by Jane C. Maxwell (2018) from the University of Texas at Austin Addiction Research Institute
outlined substance use indicators for Texas and noted the continuation on the infiltration of illicit drugs
on our U.S.-Mexico Border. A major finding for our area as compared to the rest of Texas, is the pattern
of increased use of marijuana, cocaine and heroin, unlike the increased use of methamphetamines in
the rest of the state. Another report by the West Texas HIDTA found the increased use of use of street
heroin. Specifically, the 2018 report found drug treatment admissions in El Paso County were
increasing and heroin admissions (224) were second only to marijuana admissions (257) in 2017.
Alcohol related admissions among El Paso treatment centers remained high at (341) admissions and
cocaine admissions for 2017 were (92). Total Treatment admission for El Paso County were 1,077,
(298) female and (779) were male.
The Regional Needs Assessment report services serves as a platform for the PRC10 to move forward in
highlighting the areas of need. The substance use issue continues to pervade Region 10 and can only be
reduced with outlining and identifying gaps that only data can make, and for agencies to know of the
increasing need for prevention and intervention services.
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Moving Forward The Prevention Resource Center 10 is continuously seeking new and up-to-date data that is relevant to
the region as well as the state. The RNA is filled with data that individuals, organizations and agencies
may like to examine more in-depth. Data requests or submissions can be made by contacting:
Susie Villalobos, M.Ed.
Regional Evaluator
915.782.4000
1-844-PRC-TX10 (1-844-772-8910)
@PRCRegion10
Twitter.com/PRCRegion10
Facebook.com/PRC10
www.prc10.net
Regional Contributors RNA Since 2014 the Prevention Resource Center for region 10 has published a Regional Needs Assessment
report. Each year the report becomes more inclusive and concise as to the type of data the community
needs for prevention programming. The Health and Human Services Commission for the State of
Texas supports the required assessment and the completion of the report, but local county data for
several indicators is difficult to acquire each year. Given the unique landscape of region 10 with its
urban, rural and farming communities, and shared demographics, the PRC still needs data for much of
the counties for an accurate snapshot of health and outcome behaviors. If you would be interested in
contributing to the Regional Needs Assessment, please contact the Regional Evaluator at (915) 782-
4000, to learn what information would be most helpful for the next report. The PRC for region 10 is
committed to a unified and strategic way of using data to address population needs in the region to
ultimately achieve health equity!
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Appendix A
Glossary of Terms
ACS American Community Survey
Adolescent An individual between the ages of 12 and 17 years (SAMHSA)
ATOD Alcohol, tobacco, and other drugs
BAC Blood Alcohol Concentration
BLS U.S. Bureau of Labor Statistics
BRFSS Behavioral Risk Factor Surveillance System
CAPT Southwest Regional Center for Applied Prevention Technologies
CBD Cannabinoid
CBP U.S. Customs and Border Protection
CDC Centers for Disease Control and Prevention
CHR County Health Rankings
CSAP SAMHSA's Center for Substance Abuse Prevention
Epidemiology Epidemiology is the study of the distribution and determinants of health-related states or events in specified populations, and the application of this study to the control of health problems. (CDC)
Evaluation Systematic application of scientific and statistical procedures for measuring program conceptualization, design, implementation, and utility; making comparisons based on these measurements; and the use of the resulting information to optimize program outcomes.
EWG Epidemiological Work Group
FBI UCR Federal Bureau-Investigation Uniform Crime Reporting
HHSC Texas Health and Human Service Commission
Incidence Incidence refers to the occurrence of new cases of disease or injury in a population over a specified period of time. (CDC)
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IOM Institute of Medicine
NCES National Center for Education Statistics
NIAAA National Institute on Alcohol Abuse and Alcoholism
NIDA National Institute on Drug Abuse
OCA Texas Office of Court Administration
PMP Prescription Monitoring Program
PPRI Public Policy Research Institute
PRC Prevention Resource Center
Prevalence Prevalence is the proportion of persons in a population who have a particular disease or attribute at a specified point in time or over a specified period of time. Prevalence differs from incidence in that prevalence includes all cases, both new and preexisting, in the population at the specified time, whereas incidence is limited to new cases only. (CDC)
Protective Factor Protective factors are characteristics associated with a lower likelihood of negative outcomes or that reduce a risk factor’s impact. Protective factors may be seen as positive countering events. (SAMHSA)
RE Regional Evaluator
Risk Factor Risk factors are characteristics at the biological, psychological, family, community, or cultural level that precede and are associated with a higher likelihood of negative outcomes. (SAMHSA)
RNA Regional Needs Assessment
SAMHSA Substance Abuse and Mental Health Services Administration
SNAP Supplemental Nutrition Assistance Program
SPF Strategic Prevention Framework. SAMHSA’s SPF is a planning process for preventing substance use and misuse. The five steps and two guiding principles of the SPF offer prevention professionals a comprehensive process for addressing the substance misuse and related behavioral health problems facing their communities. (SAMHSA)
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SUD Substance Use Disorder. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), no longer uses the terms substance abuse and substance dependence, rather it refers to substance use disorders, which are defined as mild, moderate, or severe to indicate the level of severity, which is determined by the number of diagnostic criteria met by an individual. Substance use disorders occur when the recurrent use of alcohol and/or drugs causes clinically and functionally significant impairment, such as health problems, disability, and failure to meet major responsibilities at work, school, or home. According to the DSM-5, a diagnosis of substance use disorder is based on evidence of impaired control, social impairment, risky use, and pharmacological criteria. Disorders include: Alcohol Use Disorder (AUD), Tobacco Use Disorder, Cannabis Use Disorder, Stimulant Use Disorder, Hallucinogen Use Disorder, and Opioid Use Disorder. (SAMHSA)
TANF Temporary Assistance for Needy Families
TDC Texas Demographic Center
TEA Texas Education Agency
TJJD Texas Juvenile Justice Department
TPII Texas Prevention Impact Index
TSDC Texas State Data Center
TSS Texas School Survey
TxDOT Texas Department of Transportation
TxDPS Texas Department of Public Safety
USCB U.S. Census Bureau
WHO World Health Organization
YRBSS Youth Risk Behavior Surveillance System
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Appendix B
List of Tables TABLE 1 - TEXAS POPULATION CHANGE PROJECTIONS, 2010-2016 17
TABLE 2 - REGION 10, POPULATION, 2010-2016 17
TABLE 3 - REGION 10, PROJECTED POPULATION RATES BY RACE, 2017 18
TABLE 4 - REGION 10, PROJECTED POPULATION RATES BY RACE, 2018 18
TABLE 5 - TEXAS VS. US POPULATION BY AGE CATEGORY, 2017 19
TABLE 6 - REGION 10 POPULATION BY AGE CATEGORY, 2017 19
TABLE 7 - TEXAS AND REGION 10 POPULATION BY RACE AND ETHNICITY, 2017 20
TABLE 8 - TEXAS AND REGION 10 POPULATION BY RACE AND ETHNICITY, 2015, 2016 20
TABLE 9 - REGION 10 POPULATION DENSITY, 2017 21
TABLE 10 - REGION 10 URBAN AND RURAL POPULATION, 2017 22
TABLE 11 - REGION 10, POPULATION IN LIMITED ENGLISH LANGUAGE HOUSEHOLDS, 2017 23
TABLE 12 - REGION 10 ENGLISH VS. SPANISH LANGUAGE POPULATION, 2014-2016 23
TABLE 13 - REGION 10, FAMILY HOUSEHOLD INCOME, 2016 24
TABLE 14 - REGION 10 MEDIAN FAMILY INCOME BY FAMILY COMPOSITION, 2016 24
TABLE 15 - EDUCATIONAL ATTAINMENT - EL PASO COUNTY COLONIAS BY ZIP CODE, 2012-2016 26
TABLE 16 - PUBLIC TRANSIT COMMUTE USE FOR WORK , 2016 27
TABLE 17 - REGION 10, LABOR FORCE, EMPLOYED/UNEMPLOYED, 2017 27
TABLE 18 - REGION 10 HOUSEHOLDS WITH PUBLIC ASSISTANCE, 2016 28
TABLE 19 - REGION 10 HOUSEHOLDS WITH PUBLIC ASSISTANCE, 2015 28
TABLE 20 - REGION 10 SNAP BENEFITS BY COUNTY, 2017 29
TABLE 21 - REGION 10 ELIGIBLE STUDENTS FOR FREE LUNCH, 2010-2016 29
TABLE 22 - NATIONAL SCHOOL LUNCH PROGRAM, 2017-2018 30
TABLE 23 - TEXAS TOTAL ENROLLMENT, 2016-2017 31
TABLE 24 - ENROLLMENT, GRADUATION RATES AND DROPOUT RATES BY COUNTY, 2016-2017 31
TABLE 25 - ENROLLMENT, GRADUATION RATES AND DROPOUT RATES BY COUNTY, 2013-2015 31
TABLE 26-32 - REGION 10 BY COUNTY, 2016-2017 ENROLLMENT 32
TABLE 33 - REGION 10 (ESC 19) SCHOOL DISTRICT TOTALS FOR ISS AND DAEP, 2016-2017 34
TABLE 34 - REGION 10 (ESC 19) SCHOOL DISTRICT TOTALS FOR ISS AND DAEP, 2015-2016 35
TABLE 35 - REGION 10 (ESC 18) SCHOOL DISTRICT TOTALS FOR ISS AND DAEP, 2016-2017 35
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TABLE 36 - REGION 10 (ESC 18) SCHOOL DISTRICT TOTALS FOR ISS AND DAEP, 2015-2016 36
TABLE 37 - JURISDICTIONAL LAW ENFORCEMENT BY COUNTY FOR REGION 10 37
TABLE 38 - STATE OF TEXAS TOTAL REPORTED CRIME, 2015-2016 37
TABLE 39 - STATE OF TEXAS TOTAL REPORTED CRIME, 2014-2015 38
TABLE 40 - INDEX VIOLENT AND PROPERTY CRIME BY COUNTY, 2016 38
TABLE 41 - INDEX VIOLENT AND PROPERTY CRIME BY COUNTY, 2015 38
TABLE 42 - FAMILY VIOLENCE IN TEXAS, 2016 39
TABLE 43 - FAMILY VIOLENCE NUMBER OF INCIDENTS BY COUNTY, 2014-2016 40
TABLE 44 - DEA STATE OF TEXAS DRUG SEIZURES, 2016 41
TABLE 45 - DRUGS SEIZED PER UNITS FOR EACH COUNTY IN REGION 10, 2014-2016 42
TABLE 46 - ARRESTS FOR DRUG ABUSE VIOLATIONS, PERCENT DISTRIBUTION, 2017 42
TABLE 47 - U.S. BORDER PATROL NATIONWIDE CHECKPOINT DRUG SEIZURES IN POUNDS 43
TABLE 48 - U.S. BORDER PATROL DRUG SEIZURES, 2012-2018 43
TABLE 49 - TYPE AND QUANTITY OF DRUG SEIZED BY COUNTY, 2018 43
TABLE 50 - REGION 10 COUNTIES NUMBER OF SUICIDES, 2012-2017 44
TABLE 51 - U.S. DATA, SUICIDE BY METHOD, 2016 44
TABLE 52 - REGION 10, YOUTH AND ADOLESCENTS CLIENTS, AGES 6-17, 2017 45
TABLE 53 - REGION 10, MENTAL HEALTH/SUBSTANCE USE AMONG ADOLESCENTS CLIENTS 45
TABLE 54 - MENTAL HEALTH/SUBSTANCE USE AMONG ADOLESCENTS CLIENTS, AGES 6-17 45
TABLE 55 - REGION 10 MENTAL HEALTH ADMISSIONS, 2017 46
TABLE 56 - REGION 10 MENTAL HEALTH BENEFICIARIES ADMISSIONS, 2015 47
TABLE 57 - REGION 10 ACCESS TO MENTAL HEALTH PROVICDERS, 2015 47
TABLE 58 - YOUTH PERCEPTION OF PARENTAL APPROVAL OF CONSUMPTION AND ACCESS 48
TABLE 59 - PREVALENCE OF PAST 30 DAY ALCOHOL USE AMONG STUDENTS 48
TABLE 60 - TEXAS HIGH SCHOOL YOUTH RISK BEHAVIOR SURVEY, ALCOHOL USE AMONG STUDENTS 49
TABLE 61 - TSS BORDER REGIONS REPORT, PERCEPTION ON TOBACCO USE 50
TABLE 62 - TSS BORDER REGIONS REPORT, PERCEPTION OF PEER CONSUMPTION OF ALCOHOL 50
TABLE 63 - TSS BORDER REGIONS REPORT, PERCEPTION OF MARIJUANA USE 50
TABLE 64 - TSS BORDER REGIONS PARENT PERCEPTION ON THE USE OF TOBACCO 51
TABLE 65 - TSS BORDER REGIONS REPORT PARENT PERCEPTION ON THE CONSUMPTION OF ALCOHOL
GRADES 7-12, 2016 51
TABLE 66 - TSS BORDER REGIONS REPORT PARENT PERCEPTION ON THE USE OF MARIJUANA 52
TABLE 67 - REGION 10 TEEN PREGNANCY RATE 2010-2016 52
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TABLE 68 - REGION 10 ALCOHOL CONSUMPTION, GRADES 7-12, 2016 54
TABLE 69 - REGION 10 ALCOHOL CONSUMPTION BY COUNTY, 2016 54
TABLE 70 - REGION 10, NUMBER OF ALCOHOL PERMITS ISSUED, 2017 55
TABLE 71 - REGION 10, NUMBER OF ALCOHOL ESTABLISHMENTS, 2018 55
TABLE 72 - REGION 10, TABC PERMITS AND DENSITY, 2015 56
TABLE 73 - TEXAS HIGHWAY PATROL CITATIONS, ALCOHOL, MARIJUANA AND ATOD, 2016 58
TABLE 74 - PRESCRIPTION MONITORING PROGRAM QUERIES, 2016-2017 60
TABLE 75 - MOST COMMONLY DIVERTED MEDICATION, 2017 61
TABLE 76 - MEDICARE PRESCRIPTION DRUG ENROLLMENT, 2017 61
TABLE 77 - REGION 10 DISPENSATIONS BY DEA SCHEDULE, 2015-2016 62
TABLE 78 - EDUCATION SERVICE CENTER 18 AND 19 (REGION 10), DISCIPLINE Data, 2017 64
TABLE 79 - SINGLE DRUG-RELATED DEATHS - DRUG INVOLVED, 2016 65
TABLE 80 - MULTIPLE DRUG-RELATED DEATHS - MOST FREQUENTLY INVOLVED DRUGS 66
TABLE 81 - SYNTHETIC MARIJUANA CONSUMPTION, GRADES 6-12, TSS 70
TABLE 82 - SYNTHETIC MARIJUANA INITIATION, GRADES 6-12, TSS 71
TABLE 83 - INMATE POPULATION, DRUG/ALCOHOL OFFENSES, 2015 75
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Appendix C
List of Figures Figure 1 - Map of Health Service Regions Serviced By the Prevention Resource Centers 6 Figure 2 - Examples of risk and protective factors within the domains of the Socio-Ecological Model 8 Figure 3 - NIAAA (2004) rubric for operationalizing the standard drink by ounces and percent alcohol across beverage type 9 Figure 4 - Strategic Prevention Framework (SPF) 12 Figure 5 - Texas Density Population 21 Figure 6 - Percentage of population in poverty by County 24 Figure 7 - Percent of Hispanics in El Paso County by block group 25 Figure 8 - Photo of a colonia homestead in El Paso County 25 Figure 9 - State of Texas Summary, Intimate Partner - by the numbers 2016 Facts and Figures 39 Figure 10 - Drug Prices in the Region as listed by West Texas HIDTA 40 Figure 11 - El Paso County Number of Drug Related Deaths, 2012-2017 65 Figure 12 - Benzodiazepines and Opioids related deaths, 2001-2015 67 Figure 13 - Cocaine and Opioids related deaths 68 Figure 14 - Drugs Involved in U.S. Overdose Deaths, 2000-2016 73 Figure 15 - Poisoning Deaths among adults, 2010-2012 74 Figure 16 - Map of Recovery Schools in the U.S., 2018 81
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References
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2. McLeroy, KR, Bibeau, D, Steckler, A, Glanz, K. (1988). An ecological perspective on health promotion programs. Health Education & Behavior, 15(4), 351-377.
3. Urban Peace Institute. Comprehensive Violence Reduction Strategy (CVRS). http://www.urbanpeaceinstitute.org/cvrs/. Retrieved May 29, 2018.
4. Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2016 State Report. 2016. http://www.texasschoolsurvey.org/Documents/Reports/State/16State712.pdf. Retrieved May 30, 2018.
5. Texas Department of State Health Services. 2001-2017 High School Youth Risk Behavior Surveillance System Data. 2017. http://healthdata.dshs.texas.gov/HealthRisks/YRBS. Retrieved April 27, 2018.
6. Substance Abuse and Mental Health Services Administration. National Survey on Drug Use and Health. 2016. https://www.samhsa.gov/data/sites/default/files/NSDUH-DetTabs-2016/NSDUH-DetTabs-2016.pdf. Retrieved May 30, 2018.
7. Substance Abuse and Mental Health Services Administration. Substance use disorders. https://www.samhsa.gov/disorders/substance-use. Updated October 27, 2015. Retrieved May 29, 2018.
8. National Institute for Alcohol Abuse and Alcoholism. What is a “standard” drink? https://www.rethinkingdrinking.niaaa.nih.gov/How-much-is-too-much/What-counts-as-a-drink/Whats-A-Standard-Drink.aspx. Retrieved May 24, 2018.
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19. Insurance Institute for Highway Safety Highway Loss Data Institute, Alcohol and Drugs 2016 Summary report, published December 2017, accessed July 2018, www.iihs.org/iihs/topics/t/alcohol-and-drugs/fatalityfacts/alcohol-and-drugs/2016.
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phenomenon. 23. National Institute on Drug Abuse, Drug Facts: Synthetic Cathinones (“Bath Salts”). 24. Centers for Disease Control and Prevention, E-cigarette use triples among middle and high
school students in just one year. 25. Centers for Disease Control and Prevention, New CDC study finds dramatic increase in e-
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Coalition Programs (CCP). 29. Ysleta del Sur Pueblo, Alcohol and Substance Abuse Program. 30. Communities In Schools, Programs, Choices. 31. Rio Grande Safe Communities, Who We Are. 32. Hanley Brown, Fay, John Kania, and Mark Kramer. "Channeling change: Making collective
impact work." Stanford Social Innovation Review 20 (2012): 1-8. 33. Kania, John, and Mark Kramer. "Collective impact." (2011): 36-41. 34. Texas Department of State Health Services, Universal, Selective, and Indicated Prevention. 35. Texas Department of State Health Services, Substance Abuse Prevention Services: Community
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https://www.drugabuse.gov/drugs-abuse/opioids. 40. Hanley Brown, Fay, John Kania, and Mark Kramer. "Channeling change: Making collective
impact work." Stanford Social Innovation Review 20 (2012): 1-8. 41. Kania, John, and Mark Kramer. "Collective impact." (2011): 36-41.
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Prevention Resource Center 10 Staff:
Julie Priego, M.A.
Divisional Director
Susie A. Villalobos, M.Ed.
Regional Evaluator
Chrystal Loveless, BSW
Project Coordinator
Ildamar Garcia, BA
Tobacco Specialist
Jesse Youngblood
Tobacco Specialist
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Prevention Resource Center 10 Social Media:
Facebook.com/prc10
Twitter.com/prcregion10
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